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Quality Assurance, UR & Case Management

Passion + Vision + Integrity = Excellence

Ensure consistency and the highest ethical standards across our entire organization. Our quality assurance team drives ongoing improvement by fostering an environment of support, providing technical and specialized consultative services, and inspiring ongoing excellence.

Patient Care Coordinator - Virginia Hospital Center

Location: Arlington, VA Job Number: 698929 Date posted: 05/18/2018
Description: The Patient Care Coordinator is responsible for utilization review, discharge planning and transitions in care, in collaboration with MAPMG rounder in acute or alternative settings of care.

Essential Responsibilities:
  • Utilization Review. According to department policy, procedure and protocols, consistently apply and verbally communicate approved utilization review criteria and guidelines for services delivered in acute or alternative care settings.
  • Eligibility and Benefit Verification. Confirm eligibility status and ensure the appropriate administration of benefits in accordance with department policies and procedures.
  • Assessing Right Venue of Care with Hospitalist. Collaboration with Hospitalist to assess the appropriate level of care for patients (i.e., Medical Unit, Surgical Unit, Tele Unit, TCU, ICU) and post- (Home, Continuum or Community-based Services) hospitalization.
  • Coordination of Care. Driving patient care plan through assuring daily plan is executed, and management of transitions and post-hospital care.
  • Effective Discharge Planning. Prompt, clinically appropriate discharge planning beginning at time of admission.
  • Variance Management. Timely steps in identification of delays in throughput, escalation to correct delays, and recording delays to identify patterns and trends that will require corrective actions.
  • Quality Screening. Demonstrate competency to assess all aspects of care across the continuum for variations from quality and utilization standards.
  • Performs other related duties as directed.


  • Basic Qualifications:
    Experience
  • Minimum two (2) years of experience in acute hospital utilization review or equivalent required.
    Education
  • N/A
    License, Certification, Registration
  • RN License in jurisdiction where assigned required.
  • BLS certification required.

    Additional Requirements:
  • New Hire: Successful completion of PCC Orientation and Assessment of Critical Skills. Passing score on inter-rater reliability.
  • Annually: Successful completion of PCC Assessment of Critical Skills. Passing score on inter-rater reliability.
  • Recent acute care, case management, or home health experience preferred.
  • Demonstrated ability to effectively and clearly present information through the written word, to influence or persuade others through oral presentation in positive or negative circumstances, and to listen well.
  • Demonstrated ability to write clearly, legibly, and effectively, to present ideas and document activities, to read and interpret written information.
  • Ability to effectively communicate.
  • Ability to conform to established policies and procedures.
  • Ability to analytically problem solve and make decisions.
  • Ability to tolerate and cope with ambiguity
  • Ability to work as a team member.
  • Proficiency in the use of applicable computer software.

    Preferred Qualifications:
  • BSN preferred.

    Primary Location: Virginia,Arlington,Virginia Hospital Center Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri, Sat, Sun; Variable Working Hours Start: 7:00 AM Working Hours End: 5:30 PM Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: UFCW - Local 400 Job Level: Individual Contributor Job Category: QA / UR / Case Management Department: Utilization Management Travel: Yes, 25 % of the Time
    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.

    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 and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.
  • About QA, Ur & Case Management Careers

    Careers In QA, Ur & Case Management

    As an organization, we are committed to delivering the same exemplary care no matter who you are, where you are, or what your needs. But how are those standards defined, measured, and assessed? That's where our quality assurance team comes in. Implementing the action plans and initiatives that will drive successful practices, you'll work across the organization to foster the necessary education, communication, and innovation that will enable us to operate as one KP — with our mission and goals in complete alignment.

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