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Kaiser Permanente Careers

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.

RN Supervisor, Case Coordination Center - Outside Utilization Resource Services

Location: Downey, CA Additional Locations:
Job Number: 780143 Date posted: 03/25/2019

Will primarily supervise the delivery of services and member care within one department of the Case Coordination Center; includes supervising a team of nursing and other technical personnel as well as clerical staff. Is responsible for assisting the manager in planning, development, implementation, delivery, evaluation and improvement of member and customer service that continues to add value and integrates appropriate standards of practice, service priorities and performance/outcome measures, and is consistent with strategic, business and organizational goals.  Reviews and evaluates the work of the staff and prepares periodic performance reports. Establishes and/or ensures compliance with standards, policies and procedures and ensures that all personnel are trained on same.

Essential Responsibilities:

  • Supervises staff including directing, motivating, guiding, providing resources, investigation and initiating corrective action as needed, to ensure harmony, team spirit and quality delivery of services.

  • Supervises day-to-day activities, coordinates departmental services and monitors appropriate outcomes.

  • Supervises operations including practice standards, staffing, payroll, budgets, fiscal management, and quality improvement.

  • Monitors the quality of service and utilization standards, assuming specific responsibility at the department level.

  • Acts as a liaison between the department and its customers (medical centers, outside facilities, members) to promptly resolve issues and to control unnecessary costs.

  • Oversees, educates and directs staff in all aspects of the department's function to provide quality, member-focused services that meet clinical standards and regulatory guidelines.

  • Works in collaboration with the physician advisor to ensure smooth departmental functioning and adherence to clinical and quality standards.

  • Works in collaboration with Kaiser facility directors, administrators and physician advisors regarding appropriate utilization of resources and  coordination of services to maintain high quality and efficiency.

  • Works in collaboration with the CCC QA director to identify, trend, and provide feedback regarding quality issues.

  • Works in collaboration with other CCC department managers and supervisors to share successful practices and provide additional cross over supervisory responsibilities as needed.

  • Analyzes statistical reports to identify the effectiveness of the department's program, analyzes trends, monitors the utilization of resources and acts on the information appropriately.

  • Ensures that all program activities are in compliance with the KP benefits and with the various regulatory agencies having influence over management of medical care and reimbursement and with government legislative directives.

  • Basic Qualifications:


  • Minimum three (3) years of management/supervisory/charge nurse experience.

  • Minimum five (5) years of clinical nursing experience relevant to given position/ department (e.g., critical care/emergency room) required.

  • Education

  • Bachelor's degree in nursing or related field.

  • License, Certification, Registration

  • Active California RN license.

  • Additional Requirements:

  • Autonomous individual with little need for direct supervision.

  • Understanding of the HMO environment and knowledge of the integrated delivery model of care.

  • Knowledge of health care trends, provider types and reimbursement issues.

  • Thorough knowledge of CMS requirements, Title XXII regulations and other regulatory agency requirements relevant to given department.

  • Excellent verbal and written communication skills including team building and collaboration abilities.

  • Excellent problem solving skills and ability to manage diverse interests with minimal supervision.

  • Must be able to work in a Labor/Management Partnership environment.

  • Preferred Qualifications:

  • N/A.
  • Primary Location: California,Downey,Downey Boeing - Independence Park 12254 Bellflower Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: Varies Working Hours End: Varies Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: Salaried, Non-Union, Exempt Job Level: Team Leader/Supervisor Job Category: QA / UR / Case Management Department: CCC-OURS (Outside Utilization Resource Services) Travel: No 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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