Quality / Resource Coordinator Rn

Provides assessment and monitoring of resource utilization, coordinates outside referrals, provider practice patterns, quality of care, and coordination of our members continuing care needs. Maintain and support a culture of compliance, ethics and integrity. Responsible for ensuring ongoing compliance for the department. Maintains knowledge of policies and procedures and performs in accordance with applicable regulatory requirements, external laws and accreditation standards as they relate to the department.

• Implements changes in contract benefits, state and federal regulations, and established review criteria guidelines.
• Determines and manages appropriate levels of care and services; using clinical knowledge, established guidelines and physician consultation.
• Consults and educates other staff, physicians, departments and members regarding resource management options that provide high quality while efficiently using available resources.
• Coordinates care with various internal and external customers to facilitate high quality, timely, and cost effective care and service.
• Synthesizes and analyzes a large volume of data related to the member, benefits, eligibility, facilities, contracts, and clinical status to identify issues and facilitate problem solving that results in continuity of care, quality of care and optimal resource management for the patient.
• This position, knows and complies with all Kaiser Permanente quality, safety, and emergency policies and procedures. Demonstrates quality and effectiveness in work habits and clinical practice in every interaction with patients, colleagues, providers, and leadership. Ensures patient safety in the preparation and provisioning of care related to but not limited to medications, procedures, infection prevention, fall prevention, including consistent use of two patient identifiers and procedural time outs. Reports safety hazards, accidents and incidents, and unsafe working conditions promptly.

• Three (3) to five (5) years of clinical experience in healthcare setting, experience in utilization review, case management, discharge planning, and managed care.

• High School Diploma or GED

• Registered Nurse License (Colorado)

• N/A

• Associates degree in Nursing
• Three (3) to five (5) years of hospital experience in ICU, CCU, Med/Surg.

PrimaryLocation : Colorado,Aurora,Waterpark I
HoursPerWeek : 1
Shift : Day
Workdays : Mon, Tue, Wed, Thu, Fri
WorkingHoursStart : 12:00 AM
WorkingHoursEnd : 11:59 PM
Job Schedule : Call-in/On-Call
Job Type : Standard
Employee Status : Regular
Employee Group/Union Affiliation : C02|UFCW|Local 7
Job Level : Individual Contributor
Job Category : Nursing Licensed & Nurse Practitioners
Department : Waterpark I - Med Ofc Admin-Ac Dept - 1608
Travel : No
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.