Continuing Care Utilization Review Coordinator RN

4 weeks ago

Dubai, United Arab Emirates Health eCareers Full time

JobSummary

Conducts utilizationreview for in-house patients and/or those members at contractedfacilities. Assists in the discharge planningprocess.

EssentialResponsibilities

  • Conducts utilization review forin-house patients and/or members who have been admitted tocontracted facilities. Interviews patients/caregivers regardingcare after hospitalization.
  • Conducts clinicalreviews based on established treatmentcriteria.
  • Collaborates with physicians onclinical reviews, keeps them appraised of Kaiser clinicalcriteria.
  • Reviews utilization patterns,identifies trends and problems areas for specialstudies.
  • Assists in collecting and assimilatingclinical data to enhance the quality ofservices.
  • Generates quality improvementresults.
  • Reports and investigates unusualoccurrences and questions inappropriate decisions based on theirprofessional expertise.
  • Assists other healthcare providers in the discharge planning process and triaging onalternative unit of care.
  • Counsels on Medicareand health care plan coverage.
  • Coordinatesreferrals to appropriateagencies/facilities.
  • Kaiser Permanente conductscompensation reviews of positions on a routine basis. At any time,Kaiser Permanente reserves the right to reevaluate and change jobdescriptions, or to change such positions from salaried to hourlypay status. Such changes are generally implemented only afternotice is given to affected employees.

Experience

BasicQualifications:

  • Minimum two (2) years of experiencein an inpatient setting OR if for Skilled Nursing departments,minimum two (2) years of experience in a skilled nursingfacility.
  • Minimum one (1) year of utilizationexperience required.

Education

  • Bachelors degree in nursing or healthrelated field required, OR four (4) years of experience in adirectly related field.Graduate of accredited school ofnursing.High School Diploma or General Education Development (GED)required.

License,Certification, Registration

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

AdditionalRequirements

  • Demonstrated knowledge of diagnosticcodes.
  • Must be able to work in aLabor/Management Partnership environment.

PreferredQualifications

  • Clinical expert in area of reviewpreferred.
  • Masters degreepreferred.

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