Continuing Care Utilization Review Coordinator RN Job at Kaiser Permanente, San Jose, CA

N3pDRzVETkRidE45TVdWTjZQcE15YWRjOGc9PQ==
  • Kaiser Permanente
  • San Jose, CA

Job Description

Job Summary: Conducts utilization review for in-house patients and/or those members at contracted facilities. Assists in the discharge planning process. Essential Responsibilities: + Conducts utilization review for in-house patients and/or members who have been admitted to contracted facilities. Interviews patients/caregivers regarding care after hospitalization. + Conducts clinical reviews based on established treatment criteria. + Collaborates with physicians on clinical reviews, keeps them appraised of Kaiser clinical criteria. + Reviews utilization patterns, identifies trends and problems areas for special studies. + Assists in collecting and assimilating clinical data to enhance the quality of services. + Generates quality improvement results. + Reports and investigates unusual occurrences and questions inappropriate decisions based on their professional expertise. + Assists other health care providers in the discharge planning process and triaging on alternative unit of care. + Counsels on Medicare and health care plan coverage. + Coordinates referrals to appropriate agencies/facilities. + 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. Secondary Functions: + Varies from Mon-Fri. Basic Qualifications: Experience + 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. Education + Bachelors degree in nursing or health related field required, OR four (4) years of experience in a directly related field.Graduate of 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. + Must be able to work in a Labor/Management Partnership environment. Preferred Qualifications: + Clinical expert in area of review preferred. + Masters degree preferred. COMPANY: KAISER TITLE: Continuing Care Utilization Review Coordinator RN LOCATION: San Jose, California REQNUMBER: 1329822 External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.

Job Tags

Hourly pay, Local area,

Similar Jobs

Bekynd Careers

Dispensary Budtender Job at Bekynd Careers

Join our fast-growing team as a Dispensary Budtender in the dynamic field of cannabis retail. We are looking for enthusiastic individuals passionate about helping customers find the best cannabis products to suit their needs. As a Budtender, you will be at the forefront... 

Gpac

Business Loan Officer Job at Gpac

A community bank is confidentially looking to add another member to their banking family....  ...advance their career. The Business Loan Officer is responsible for developing new business...  ...account activity.* Coordinate and assist back-office personnel in resolving credit... 

Montefiore Medical Center

PI/PC UNIFIED MANAGER Job at Montefiore Medical Center

 ...Quality/ Safety Manager, Unified Department of Radiology The position is responsible for the establishment, implementation and monitoring of the centralized Performance Improvement/Performance Control Plan for the Department of Radiology under the direction of the... 

Crunch Fitness - CR Holdings

District Manager Job at Crunch Fitness - CR Holdings

 ...District Manager Here We GROW Again! Are you a potential District Manager and ready to leave average in the past? Be a part of one of the greatest growth stories ever told in the fitness industry. With 70+ locations currently and 100+ locations planned; our... 

Safeway Home Health Care

Mental Health Practitioner Job at Safeway Home Health Care

 ...serious persistent mental illnesses and co-occurring substance use disorders. This includes providing instruction, support, and assistance to promote psychiatric stability, social competencies, personal and emotional adjustment, community integration, and independent...