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Continuing Care Utilization Review Coordinator RN

2 months ago

San Francisco, California, United States Kaiser Permanente Full time
Job Summary:

Kaiser Permanente is seeking a skilled Utilization Review Coordinator RN to join our team. As a key member of our healthcare team, you will be responsible for conducting utilization reviews for in-house patients and/or those members at contracted facilities. Your expertise will be essential in assisting with the discharge planning process and ensuring that our patients receive the highest quality care.

Key Responsibilities:
  • Conduct thorough utilization reviews for in-house patients and/or members who have been admitted to contracted facilities.
  • Interview patients/caregivers to gather information regarding care after hospitalization.
  • Collaborate with physicians to review clinical data and ensure that our patients receive the most appropriate care.
  • Identify trends and problem areas in utilization patterns and develop strategies to improve care.
  • Assist in collecting and analyzing clinical data to enhance the quality of our services.
  • Generate reports and quality improvement results to inform our care delivery.
  • Investigate unusual occurrences and question inappropriate decisions based on your professional expertise.
  • Assist other healthcare providers in the discharge planning process and triaging on alternative units of care.
  • Counsel patients on Medicare and health plan coverage.
  • Coordinate referrals to appropriate agencies/facilities.
Requirements:
  • Minimum two (2) years of experience in an inpatient setting OR two (2) years of experience in a skilled nursing facility.
  • Minimum one (1) year of utilization experience required.
  • Bachelor's degree in nursing or a health-related field required, OR four (4) 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) required.
  • Registered Nurse License (California) required.
  • Basic Life Support certification required.
Preferred Qualifications:
  • Clinical expertise in the area of review preferred.
  • Masters degree preferred.