Company: Kaiser Permanente
Location: Santa Ana
Posted on: May 25, 2023
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
- 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
- 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
- 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
- Registered Nurse License (California) -Additional
- 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.PrimaryLocation : California,Walnut
Creek,501 Lennon LaneHoursPerWeek : 40Shift : EveningWorkdays :
Mon, Tue, Wed, Thu, Fri *Every other weekendWorkingHoursStart :
03:00 PMWorkingHoursEnd : 11:30 PMJob Schedule : Full-timeJob Type
: StandardEmployee Status : RegularEmployee Group/Union Affiliation
: NUE-NCAL-09-NUE-Non Union EmployeeJob Level : Individual
ContributorJob Category : Nursing Licensed & Nurse
PractitionersDepartment : Walnut Creek 501 Lennon Lane - Rgnl
Pres-Hp & Hosp O/S Svcs - 0201Travel : NoKaiser 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.
Keywords: Kaiser Permanente, Santa Ana , Claims Analyst, Professions , Santa Ana, California
Didn't find what you're looking for? Search again!
Loading more jobs...