Continuing Care Utilization Review Coordinator Rn (Out Patient Experience Only)

Conducts utilization review for in-house patients and/or those members at contracted facilities. Assists in the discharge planning process.

• Conducts clinical reviews based on established treatment criteria.
• Generates quality improvement results.
• Coordinates referrals to appropriate agencies/facilities.
• Reports and investigates unusual occurrences and questions inappropriate decisions based on their professional expertise.
• Counsels on Medicare and health care plan coverage.
• Assists in collecting and assimilating clinical data to enhance the quality of services.
• Reviews utilization patterns, identifies trends and problems areas for special studies.
• Collaborates with physicians on clinical reviews, keeps them appraised of Kaiser clinical criteria.
• Kaiser Permanente conducts compensation reviews of positions on a routine basis. At any time, Kaiser Permanente reserves the right to reevaluate and change job descriptions, or to change such positions from salaried to hourly pay status. Such changes are generally implemented only after notice is given to affected employees.
• Assists other health care providers in the discharge planning process and triaging on alternative unit of care.
• Conducts utilization review for in-house patients and/or members who have been admitted to contracted facilities. Interviews patients/caregivers regarding care after hospitalization.

Notes:

• Telephonic and In-person visits.
• Longitudinal Medi-Cal Case management working closely with RN's and Social work team.

• Minimum two (2) years of experience in an inpatient setting OR if for Skilled Nursing departments, minimum two (2) years of experience in a skilled nursing facility.
• Minimum one (1) year of utilization experience required.

• Graduate of accredited school of nursing.
• High School Diploma or General Education Development (GED) required.
• Bachelors degree in nursing or health related field required, OR four (4) years of experience in a directly related field.

• Registered Nurse License (California)

• Demonstrated knowledge of diagnostic codes.
• Must be able to work in a Labor/Management Partnership environment.

• Masters degree preferred.
• Clinical expert in area of review preferred.

PrimaryLocation : California,Santa Clara,Santa Clara 3900 Freedom Support
HoursPerWeek : 40
Shift : Day
Workdays : Mon, Tue, Wed, Thu, Fri
WorkingHoursStart : 08:30 AM
WorkingHoursEnd : 05:30 PM
Job Schedule : Full-time
Job Type : Standard
Employee Status : Regular
Employee Group/Union Affiliation : NUE-NCAL-09|NUE|Non Union Employee
Job Level : Individual Contributor
Job Category : Nursing Licensed & Nurse Practitioners
Department : Oakland Reg - 1950 Franklin - Rgnl Pres-Amb Nrsng Adm&Strtgy - 0208
Travel : Yes, 20 % of the Time
Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.