Continuing Care Utilization Review Coordinator RN

About the position The Continuing Care Utilization Review Coordinator RN plays a crucial role in ensuring the quality of care for patients within Kaiser Permanente's network. This position involves conducting utilization reviews for in-house patients and those admitted to contracted facilities. The coordinator is responsible for interviewing patients and caregivers to assess care needs post-hospitalization and conducting clinical reviews based on established treatment criteria. Collaboration with physicians is essential, as the coordinator must keep them informed of Kaiser clinical criteria and assist in the discharge planning process. In addition to clinical reviews, the coordinator will analyze utilization patterns, identify trends, and address problem areas through special studies. This role also includes collecting and assimilating clinical data to enhance service quality and generating quality improvement results. The coordinator is tasked with reporting and investigating unusual occurrences and questioning inappropriate decisions based on their professional expertise. Furthermore, they will provide counseling on Medicare and health care plan coverage and coordinate referrals to appropriate agencies and facilities. This position is part-time, requiring a commitment of 24 hours per week, primarily during the day shift from Monday to Friday. The role is based in San Francisco, CA, and involves a significant amount of travel, estimated at 50% of the time, to various facilities as needed. The coordinator must be adaptable and ready to work in a Labor/Management Partnership environment, reflecting Kaiser Permanente's commitment to quality care and employee engagement. 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, keeping 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. Requirements • 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. , • Registered Nurse License (California) required. , • Basic Life Support certification required. Nice-to-haves • Clinical expert in area of review preferred. , • Master's degree preferred.

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