Continuing Care Utilization Review Coordinator RN - SNF Job at Kaiser, San Jose, CA

dy9aaVNRZ2F5RmVpblphQW5HMXFRWGNJbVE9PQ==
  • Kaiser
  • San Jose, CA

Job Description

Job Description

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 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.

Secondary Functions:


  • Varies from Mon-Fri. 

Basic Qualifications:

Experience

  • 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.

Education

  • 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

  • Driver's License (California)
  • Registered Nurse License (California)
  • Basic Life Support

Additional Requirements:

  • 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,San Jose,San Jose 50 Great Oaks
HoursPerWeek : 20
Shift : Day
Workdays : Mon, Tue, Wed, Thu, Fri
WorkingHoursStart : 08:30 AM
WorkingHoursEnd : 05:00 PM
Job Schedule : Part-time
Job Type : Standard
Employee Status : Regular
Employee Group/Union Affiliation : NUE-NCAL-09|NUE|Non Union Employee
Job Level : Individual Contributor
Job Category : Nursing Licensed & Nurse Practitioners
Department : San Jose Hospital - OSM Svc Admin-SNF - 0201
Travel : Yes, 75 % of the Time
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.

Job Tags

Hourly pay, Part time, Shift work,

Similar Jobs

Del Real Foods

Food Science Intern Job at Del Real Foods

 ...We are seeking a highly motivated Food Science Intern to support our R&D team by reviewing, updating, and refining detailed product specifications for our top 10 priority products. This project-based role is ideal for a junior or senior majoring in Food Science, Food... 

Charter Foods, Inc

Crew Member: Customer Service / Cashier Job at Charter Foods, Inc

The Crew Member: Customer Service / Cashier is the key to ensuring guest satisfaction. This is a very important position for a friendly, helpful individual who enjoys working in a fast-paced environment. Why should you apply? Free Meals during your shift Flexible... 

Colas USA

Business Data Analyst II Job at Colas USA

 ...Data Business Analyst, II (BA II), is responsible for contributing to the development and execution of data solutions to support organizational decision-making. This position requires proficiency in mapping intermediate and simple PowerBI solutions independently and the... 

St. Louis Park Public Schools

2025-26 Music Teacher - High School Job at St. Louis Park Public Schools

 ...Title: Teacher-Music DBM Classification: C43/Grade14 Department: High School Salary Range: $47,066 - $103,660 Employee Group: P.A.T- Teachers Prepared Date: May 2025 Reports to: High School Principal FTE/ FLSA Status: 1.00-10-... 

MedStar Health

Cardiac Interventional Technologist Job at MedStar Health

 ...media into the coronary arteries as directed by a Cardiologist during a cardiac catheterization procedure. Recognizes the effect of pathology and vital signs to determine the amount of pressure of each hand injection. Functions as a first assistant to the physician by...