Utilization Coordinator Registered Nurse

DEPARTMENT: OUTSIDE SERVICES SCHEDULE: Part-time, Regular; 20 hours/ week; Day Shift. ***The days of week will be determined upon start of position. For more information see below*** EDUCATION/ LICENSE/CERTIFICATION: BSN or BA in health care related field preferred. Graduate of accredited school of nursing. Current California RN license. PHN preferred. POSITION SUMMARY: Conducts utilization review for in-house patients and those members at contracted facilities. Assists in the discharge planning process. QUALIFICATIONS: Previous experience in an inpatient setting (usually 2 years). Previous experience utilization experience required (usually 1 year). Clinical expert in area of review preferred. Demonstrated knowledge of diagnostic codes. PREFERRED QUALIFICATIONS: A minimum of five (5) years clinical experience as an RN, including work the area of clinical specialty. Case management or utilization management preferred. Current performance evaluation at the midpoint or above. DUTIES: Conducts utilization review for in-house patients as well as those members who have admitted to contracted facilities. Conducts clinical reviews based on established treatment criteria. Reviews utilization patterns, identifies trends and problems areas for special studies. Assists other health care providers in the discharge planning process and triaging on alternative unit of care. Assists in collecting and assimilating clinical data to enhance the quality of services. Generates quality improvement results. Collaborates with physicians on clinical reviews, keeps them appraised of Kaiser clinical criteria. Reports and investigates unusual occurrences and questions inappropriate decisions based on their professional expertise. Interviews patients/caregivers regarding care after hospitalization. Counsels on Medicare and health care plan coverage. Coordinates referrals to appropriate agencies/facilities. Consistently supports compliance and the Principles of Responsibility (Kaiser Permanente's Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable federal, state and local laws and regulations, accreditation and licenser requirements (if applicable), and Kaiser Permanente's policies and procedures. 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. OTHER DUTIES: As a member of the Outside Services Department Team, the RN provides oversight for the management of high risk/high utilizer case management program. The program identifies, educates, and case manages members that frequent non-Kaiser facilities. The case managers responsibilities include arrangement for appropriate follow-up care, coordination of care, education of members, improvement of patient and family satisfaction, identification of high utilizers / high risk members, collaboration with physicians, and reduction of outpatient and inpatient claims cost. The case manager will assist in claims case management. The department operates 7 days a week. All case managers are responsible to work weekends. Schedules vary based on staffing and weekend coverage. To apply online go to www.jobs.kp.org and reference job code SL.0800156. This position supports Kaiser Permanente's code of conduct and compliance by adhering to all laws and regulations, accreditation and Licensure requirements, and internal policies and procedures. Kaiser Permanente is proud to be an equal opportunity/affirmative action employer. Additional Information Reference Code: Utilization Coordinator Registered Nurse Position Type: Part Time, Employee