Continuing Care Utilization Review Coordinator RN

1 week 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.

Essential Responsibilities:
  • Conduct thorough utilization reviews for in-house patients and/or members who have been admitted to contracted facilities, gathering information and insights to inform care decisions.
  • Interview patients and caregivers to understand their needs and preferences, and provide guidance on post-hospitalization care.
  • Collaborate with physicians to review clinical data and ensure that care is aligned with established treatment criteria.
  • Identify trends and areas for improvement in utilization patterns, and contribute to quality improvement initiatives.
  • Assist in collecting and analyzing clinical data to enhance the quality of services and inform care decisions.
  • Develop and implement quality improvement plans to address areas of concern.
  • Investigate and report on unusual occurrences and questionable decisions, using your expertise to inform care decisions.
  • Work closely with healthcare providers to facilitate discharge planning and triage patients to alternative units of care.
  • Counsel patients on Medicare and health plan coverage, and coordinate referrals to relevant agencies and facilities.
Basic Qualifications:
  • 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.
Education:
  • 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.
License, Certification, Registration:
  • Driver's License (California).
  • Registered Nurse License (California).
  • Basic Life Support.
Additional Requirements:
  • Demonstrated knowledge of diagnostic codes.
  • Ability to work in a Labor/Management Partnership environment.
Preferred Qualifications:
  • Clinical expertise in the area of review preferred.
  • Masters degree preferred.


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