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Contingent Care Utilization Review Coordinator RN

Location: Cupertino, California;

Job ID : 2411714


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:
- 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.
- 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.

Preferred Qualifications:
- Clinical expert in area of review preferred.
- Master's degree preferred.

Primary Location:California,Cupertino,Santa Clara Tantau Medical Offices 19000 Homestead

Scheduled Hours (1-40):0


Working Days:Mon - Fri


Job Type:Standard

Employee Status:Regular

Employee Group:Non-Union, Non-Exempt

Job Level:Individual Contributor

Job:Nursing Licensed

Public Department Name:Skilled Nursing Coordinator- RN

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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