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Nurse Consultant
2 months ago
{"Job Title": "Nurse Consultant", "Job Summary": "As a Nurse Consultant at Kaiser Permanente, you will play a critical role in providing clinical expertise to ensure compliance with medical necessity and quality concerns. You will work closely with the Director of Risk Management, Quality and Patient Safety Teams, and other clinical professionals to investigate and resolve complex member requests and appeals. Your expertise will be essential in reviewing and analyzing audit-related reports, providing consultation on non-compliance, and drafting Quality of Care letters to contracted facilities.
**Key Responsibilities:**
* Provide clinical expertise for areas of compliance involving medical necessity and/or quality concerns
* Interpret clinical cases, including grievances and appeals, and present appropriate clinical material for Physician review
* Review member complaints to identify potential quality issues and refer them to local Quality Departments
* Draft Quality of Care letters to contracted facilities and track responses
* Provide direct support and consultation on corrective actions developed by departments for areas of non-compliance
* Utilize clinical expertise to conduct investigations and seek input from other clinical professionals as required
* Act as a liaison, problem-solver, and negotiator to achieve resolution on member requests and appeals
* Lead and/or represent Regulatory Compliance at routine and ad hoc meetings on specific compliance areas relating to GA state regulations
* Maintain database and provide timely notice of updates and implementation timeframes according to regulations
**Requirements:**
* Minimum five (5) years experience and knowledge in subject matter area of expertise
* Graduate of an accredited nursing program
* Registered Nurse Degree required
* Registered Professional Nurse License (Georgia) required at hire
* Knowledge of computer skills, data base management, and Microsoft Office
* Excellent interpersonal, verbal, and written communication skills
* Ability to work with peers in self-managed teams to meet deadlines
* Demonstrated conflict resolution and mediation skills with ability to secure action from persons outside their supervision
* Ability to use sound judgment and to handle potentially charged issues independently but with the knowledge and ability to escalate and ask for help when needed
* Ability to multi-task and manage time in order to perform well on long-term projects while being flexible enough to assimilate short term projects on an on-going basis
**Preferred Qualifications:**
* Bachelors Degree in health related field
**About Kaiser Permanente:**
Kaiser Permanente is a leading healthcare organization dedicated to providing high-quality, patient-centered care. We are committed to improving the health of our members and the communities we serve.
**Why Join Us:**
At Kaiser Permanente, we offer a dynamic and supportive work environment that fosters growth and development. We are committed to diversity, equity, and inclusion and strive to create a workplace that reflects the communities we serve.
**How to Apply:**
If you are a motivated and experienced professional looking for a challenging and rewarding opportunity, please submit your application.
**Equal Employment Opportunity:**
Kaiser Permanente is an equal opportunity employer and welcomes applications from diverse candidates.
**Accommodations:**
Kaiser Permanente provides reasonable accommodations for qualified individuals with disabilities.
**Contact Information:**
For more information, please contact [insert contact information].
**Disclaimer:**
Kaiser Permanente is not responsible for any errors or omissions in this job posting.
**Note:**
This job posting is for informational purposes only and is not a guarantee of employment.
**Kaiser Permanente is an equal opportunity employer and welcomes applications from diverse candidates.
**Accommodations:**
Kaiser Permanente provides reasonable accommodations for qualified individuals with disabilities.
**Contact Information:**
For more information, please contact [insert contact information].
**Disclaimer:**
Kaiser Permanente is not responsible for any errors or omissions in this job posting.
**Note:**
This job posting is for informational purposes only and is not a guarantee of employment.
