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Continuing Care Utilization Review Coordinator RN

2 months ago

San Carlos, California, United States Kaiser Full time
Job Summary:

Kaiser Permanente seeks a skilled Utilization Review Coordinator RN to conduct thorough reviews of patient care and assist in discharge planning. This role requires strong clinical expertise and excellent communication skills.

Key Responsibilities:
  • Conduct utilization reviews for in-house patients and contracted facilities, ensuring high-quality care and efficient resource allocation.
  • Collaborate with physicians to review clinical data and make informed decisions about patient care.
  • Identify trends and areas for improvement in utilization patterns, contributing to quality improvement initiatives.
  • Assist in collecting and analyzing clinical data to enhance service quality and patient outcomes.
  • Generate reports and investigate unusual occurrences, utilizing professional expertise to inform decision-making.
  • Support discharge planning and triage processes, ensuring seamless transitions of care.
  • Counsel patients on Medicare and health plan coverage, providing clear guidance and support.
  • Coordinate referrals to relevant agencies and facilities, streamlining care coordination.
Requirements:
  • Minimum two years of experience in an inpatient setting or skilled nursing facility.
  • One year of utilization experience required.
  • Bachelor's degree in nursing or health-related field, or four years of experience in a directly related field.
  • Graduate of an accredited school of nursing.
  • High School Diploma or General Education Development (GED) required.
  • Driver's License (California) and Registered Nurse License (California) required.
  • Basic Life Support certification.
Preferred Qualifications:
  • Clinical expertise in area of review preferred.
  • Masters degree preferred.