Continuing Care Utilization Review Coordinator RN (
Job Number: 530982 )
Working for an organization with the size and resources of Kaiser Permanente Northern California means having the potential to positively affect the health and well-being of entire communities. From our financial, business, and IT experts, to our RNs, allied health professionals, and physicians, we work together to provide the best care experience to our members and the communities we serve. As one of the most diverse regions in the country, Northern California offers everything from the majestic Sierra Mountains, to breathtaking Yosemite, to world-renowned Napa Valley. Here, you'll discover the cultural and recreational diversity that makes Northern California one of the most desirable places in the world to live and work. As Northern California's largest health plan, Kaiser Permanente provides you with the resources and opportunity to build a rewarding career in an environment that supports your success. Join us.
Description
As part of the GMC Care Coordination program, this role will be a part of a multi-disciplinary team responsible for coordinating the continuum of care services for Kaiser Permanente's GMC Medi-Cal Managed Care members. The Care Coordination team ensures members proceed efficiently through the course of services. Working with MSWs, this role will administer risk assessments to identify medical and psychosocial needs, create care plans, and initiate referrals to Kaiser Permanente physicians and programs based on member's medical and psychosocial needs. Working in a collaborative patient centered model, this role will assist members in obtaining Kaiser Permanente and community support resources, monitor members' progress, perform intervention actions on behalf of members, help members understand post-discharge procedures, and provide other member support services.
Conducts utilization review for in-house patients and/or those members at contracted facilities. Assists in the discharge planning process.
Essential Functions:
• 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.
Qualifications
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 • Bachelor's 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 • Current California RN license.
Additional Requirements: • Demonstrated knowledge of diagnostic codes. • Must be able to work in a Labor/Management Partnership environment.
• BLS & Driver License required.
Preferred Qualifications: • Clinical expert in area of review preferred. • Master's degree preferred.
• Prefer bilingual, experience in Pediatrics, and worked with underserved populations .
Primary Location : California-Sacramento-Sacramento Arden Annex 3240 Arden Wy.
Scheduled Hours (1-40) : 40
Shift : Day
Working Days : Mon -Fri, rotating Sat
Working Hours Start : 11:00 AM
Working Hours End : 7:30 PM
Schedule : Full-time
Job Type : Standard
Employee Status : Regular
Employee Group (Union Affiliation) : Non-Union, Non-Exempt
Job Level : Individual Contributor
Job : Continuing Care (Home Health / Hospice / SNF)
Public Department Name : Geographic Managed Care (Medi-Cal)
Travel : Yes, 25 % of the Time
Job Eligible for Benefits : Yes
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.
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