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.

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.

Primary Location: California,Oakland,Oakland 4501 Broadway Admin
Scheduled Weekly Hours: 1
Shift: Day
Workdays: Mon, Tue, Wed, Thu, Fri
Working Hours Start: 08:30 AM
Working Hours End: 05:00 PM
Job Schedule: Call-in/On-Call
Job Type: Standard
Worker Location: Onsite
Employee Status: Regular
Employee Group/Union Affiliation: NUE-NCAL-09|NUE|Non Union Employee
Job Level: Individual Contributor
Department: Oakland Hospital - OSM Svc Admin-SNF - 0201
Pay Range: $73.02 - $94.5 / hour The ranges posted above reflect the location in the job posting. The salary range may vary if you reside in a different location or state than the location posted.
Travel: Yes, 75 % of the Time
On-site: Work location is on-site (KP designated office, medical office building or hospital). Worker location must align with Kaiser Permanente's Authorized States policy. At Kaiser Permanente, equity, inclusion and diversity are inextricably linked to our mission, and we aim to make it a part of everything we do. We know that having a diverse and inclusive workforce makes Kaiser Permanente a better place to receive health care, a more supportive partner in our communities we serve, and a more fulfilling place to work. Working at Kaiser Permanente means that you agree to and abide by our commitment to equity and our expectation that we all work together to create an inclusive work environment focused on a sense of belonging and wellbeing.

Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status. Submit Interest

---