The Front Line of Patient Care
Our nurse professionals embody what it means to provide the best patient interactions possible. They also advance the art and science of nursing in a patient-centered, healing environment.
Continuing Care Utilization Review Coordinator RNLocation: Modesto, CA Additional Locations:
Job Number: 863788 Date posted: 03/26/2020
Conducts utilization review for in-house patients and/or those members at contracted facilities. Assists in the discharge planning process.
- 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.
- 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.
- Bachelor's 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
- Current California RN license.
- Demonstrated knowledge of diagnostic codes.
- Must be able to work in a Labor/Management Partnership environment.
- Clinical expert in area of review preferred.
- Master's degree preferred.
- Palliative Care experience preferred.
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 Nursing & Physician Assistant Careers
Through professional practice and leadership, nurses at Kaiser Permanente continually advance the art and science of nursing. But we recognize that what we do is more than clinical practice. We believe that every interaction — whether it is with a patient, a colleague, a physician, or anyone else — has the potential to be extraordinary. And we find that approaching our daily routine with this in mind gives each and every action new meaning and allows us to focus on the moment, empowering us to deliver expert care.
No matter where you are in your nursing career, the size and scope of our organization means you have the resources, technology, tools, and support you need to make a lasting impact.
Physician Assistant Careers
Physician assistants play a powerful and important role in delivering high-quality, informative care. Working directly with patients, their families, colleagues, and supervising physicians, they are vital in defining the overall care experience.
Being a physician assistant at Kaiser Permanente is centered on promoting a healing environment — one that maintains a caring, comforting practice while honoring the unity of the whole patient: mind, body, and spirit.
See What People are Saying About Working at KP
Come introduce yourself to a member of the Kaiser Permanente team at an upcoming career or professional event. We look forward to meeting you in person.
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