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Incident Management Consultant IV, Registered Nurse Review

Primary Location Corona, California Schedule Full-time Shift Day Salary $144400 - $186780 / year
Job Number 1390908 Date posted 11/04/2025
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At Kaiser Permanente our nurses are leaders, clinicians, researchers, innovators, and scientists who are contributing toward being an industry-leading voice for advancing evidence-based care. Whether supporting the patient directly in our hospitals or clinics, providing care at home, serving our patients through innovative virtual technology, or managing care delivery teams, Kaiser Permanente nurses utilize scientific evidence and our integrated care model to optimize the total health of our members and the communities we serve. We invite nurses who are passionate about nursing excellence, high-quality compassionate care delivery, professionalism, integrity, teamwork and patient and family centeredness to join our teams so that we can continue to sustain and build upon our culture of excellence.

  • Job Schedule: Full-time
  • Scheduled Weekly Hours:
  • Shift: Day

Success Profile

We’re looking for Nurse Leaders who possess the following traits.

  • Collaborative
  • Compassionate
  • Flexible
  • Leadership
  • Socially Conscientious
  • Trustworthy

Benefits

We offer several benefits to our nurses.

Our Culture

At Kaiser Permanente, we cultivate an environment of compassion, integrity, trust, and open communication that helps our teams do their best work. We believe that lifelong learning will expand our knowledge so we can better serve our patients. Our practice is rooted in research and evidence-based care. Our nurses reflect the rich diversity of our members and communities and provide culturally responsive and competent care that promotes understanding of our members needs and preferences. At Kaiser Permanente, nurses are highly skilled professionals who exemplify leadership, critical thinking, and collaborative problem solving and deliver the right care, at the right time, in the right setting.

Hear From Our People

Caitlin

Caitlin

Inpatient Lactation Consultant

As an RN/IBCLC in Maternal Child, I’m meeting families at a pivotal time — I’m there to help launch a new family into the world. Everything I do has the potential to impact a family’s health for generations to come.

Kimberly

Kimberly

Quality Coordinator RN

In Hawaii, your community is your family — or ‘ohana.’ I am able to provide extraordinary patient-centered care to my ohana.

David

David

Appointment and Advice RN

The location is fantastic. Kaiser Permanente is all over the country. You can pick almost any environment you want — from ocean to mountain to city. You’ll still be able to contribute to our mission of providing high quality health care at a local facility.

Shawn

Shawn

BSN, RN

I chose Kaiser Permanente because their staff and providers really show that they care about you. Also, throughout my 12 years of working here I’m always learning something new, and I’ve had many opportunities for growth and development.

Kristen

Kristen

Relief Charge Nurse

Working as a nurse at Kaiser Permanente has allowed me the perfect flexible schedule so that I can volunteer as Girl Scout Leader and room parent for both my children. My kids know that I am a hardworking mother who can provide, as well as a mom who can be present and be there for them – and that means everything to me.

Jazmin

Jazmin

RN, Advice Nurse

Working for Kaiser Permanente has allowed me to take control of my future and make my goals a possibility. I feel that Kaiser Permanente allows me to keep climbing and moving. Having that ability truly makes me feel empowered.

Incident Management Consultant IV, Registered Nurse Review

Primary Location Corona, California Schedule Full-time Shift Day Salary $144400 - $186780 / year
Job Number 1390908 Date Posted 11/04/2025
Submit Interest
Description:
Job Summary:

In addition to the responsibilities listed below, this position also reviews, evaluates potential quality outcomes, and resolves complaints, grievances, and appeals by leveraging medical knowledge and maintaining compliance to medical protocols, referral methods, claims submission processes, and regulatory guidelines; examining available medical records and treatment summaries to conduct a clinical review of moderately complex coverage requests based on medical necessity criteria, individual coverage contracts, specific health plans, coding rules, and/or other regulatory standards; documenting the review process including decisions for determination of coverage, questions for the physician, and/or potential denials to the physician review staff, independently;supporting the development and implementation of new criteria or changes in existing criteria; and providing consultation to stakeholders regarding medical necessity criteria, contract terms, interpretation of contract language, and notification of determination outcomes.

Essential Responsibilities:

  • Promotes learning in others by proactively providing and/or developing information, resources, advice, and expertise with coworkers and members; builds relationships with cross-functional/external stakeholders and customers. Listens to, seeks, and addresses performance feedback; proactively provides actionable feedback to others and to managers. Pursues self-development; creates and executes plans to capitalize on strengths and develop weaknesses; leads by influencing others through technical explanations and examples and provides options and recommendations. Adopts new responsibilities; adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; champions change and helps others adapt to new tasks and processes. Facilitates team collaboration to support a business outcome.

  • Completes work assignments autonomously and supports business-specific projects by applying expertise in subject area and business knowledge to generate creative solutions; encourages team members to adapt to and follow all procedures and policies. Collaborates cross-functionally and/or externally to achieve effective business decisions; provides recommendations and solves complex problems; escalates high-priority issues or risks, as appropriate; monitors progress and results. Supports the development of work plans to meet business priorities and deadlines; identifies resources to accomplish priorities and deadlines. Identifies, speaks up, and capitalizes on improvement opportunities across teams; uses influence to guide others and engages stakeholders to achieve appropriate solutions.

  • Drives member, customer, or employee incident case management by: monitoring and analyzing the case tracking database to identify complex, specialty, or flagged cases across all lines of business that require resolution, as well as reporting trends to management; processing complex, specialty/flagged, or high risk incident cases across all lines of business; and ensuring compliance of own work with internal and external rules and regulations in the performance of case management activities with no review necessary.

  • Performs member or employee incident case research by: investigating claims, authorizations, member contracts, and/or customer service interactions across members and customers to make determinations for complex and specialty or flagged incident cases.

  • Resolves member or employee incident cases by: making decisions regarding complex or specialty/flagged incident cases through interacting with business leaders and other stakeholders and monitoring the decisions of others; and resolving complex or specialty/flagged cases and implementing case decisions at multiple levels.

  • Performs customer service by: providing accurate information to members, customers, employees, or other stakeholders related to complex or specialty/flagged case statuses and outcomes in an appropriate timeframe; and communicating with and diffusing frustrated members, customers, or other stakeholders in complex or specialty/flagged cases involving highly charged, sometimes emotional situations.

  • Performs case documentation by: maintaining confidentiality of member, customer, or employee information throughout numerous documentation activities for complex or specialty/flagged cases; and documenting complex or specialty/flagged cases in accordance with all internal and external requirements.
Minimum Qualifications:

  • Minimum four (4) years of experience in an inpatient setting, clinic, and/or skilled nursing department or a directly health-related field.

  • Minimum two (2) years of experience in customer service or a directly related field.

  • Minimum one (1) year of experience in a leadership role with or without direct reports.

  • Bachelors degree in Business Administration, Economics, Health Care Administration, Health Services, Communications, or related field AND minimum four (4) years of experience in health care, health insurance, sales and marketing, or a directly related field OR Minimum seven (7) years of experience in health care, health insurance, sales and marketing, or a directly related field.


  • Registered Nurse License (California) required at hire
  • Basic Life Support required at hire
Additional Requirements:

  • Knowledge, Skills, and Abilities (KSAs): Clinical Risk Assessment; Health Records; Quality Assurance and Effectiveness; Nursing Principles; Information Gathering; Negotiation; Incident Management; Health Care Compliance; Maintain Files and Records; Data Entry; Acts with Compassion; Interpersonal Skills; Managing Diverse Relationships; Relationship Building; Stakeholder Management; Incident Escalation; Managing Complexity; Time Management; Service Focus; Adaptability; Stress Tolerance; Member Service; Patient Safety; Microsoft Office; Presentation Skills; Incident & Complaint Processes; Business Process Improvement; Trend Analysis; Conflict Resolution

Preferred Qualifications:
  • N/A
Primary Location: California,Corona,Corona Member Service Call Center Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: 08:00 AM Working Hours End: 05:00 PM Job Schedule: Full-time Job Type: Standard Worker Location: Remote Employee Status: Regular Employee Group/Union Affiliation: NUE-SCAL-01|NUE|Non Union Employee Job Level: Individual Contributor Department: Vandever MOB - Grp Rltn-Sales&Mrktng Integrtn - 0808 Pay Range: $144400 - $186780 / year Kaiser Permanente strives to offer a market competitive total rewards package and is committed to pay equity and transparency. The posted pay range is based on possible base salaries for the role and does not reflect the full value of our total rewards package. Actual base pay determined at offer will be based on labor market data and a candidate's years of relevant work experience, education, certifications, skills, and geographic location. Travel: No Remote: Work location is the remote workplace (from home) within KP authorized states. Worker location must align with Kaiser Permanente's Authorized States policy. Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status.

For jobs where work will be performed in unincorporated LA County, the employer provides the following statement in accordance with the Los Angeles County Fair Chance Ordinance. Criminal history may have a direct, adverse, and negative relationship on the following job duties, potentially resulting in the withdrawal of the conditional offer of employment:

  • 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 licensure requirements (where applicable), and Kaiser Permanente's policies and procedures.

  • Models and reinforces ethical behavior in self and others in accordance with the Principles of Responsibility, adheres to organizational policies and guidelines; supports compliance initiatives; maintains confidences; admits mistakes; conducts business with honesty, shows consistency in words and actions; follows through on commitments.

  • Job duties with at least occasional or possible access to: (1) patients, the general public, or other employees; (2) confidential protected health information and other confidential KP information (including employee, proprietary, financial or trade secret information); (3) KP property and assets, for example, electronic assets, medical instruments, or devices; (4) controlled substances regulated by federal law or potentially subject to diversion.
    •
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