Continuing Care/Utilization Review Crd RN (6314)
DEPARTMENT: SNF/Cont CareSCHEDULE: Full time regular, 40 hours/week, Day shift, Monday-Friday including Saturday and Sunday. Requires travel between Medical Centers and assigned SNF´s within Service Areas.EDUCATION/LICENSE/CERTIFICATION: BSN or BA in health care related field preferred. Graduate of accredited school of nursing. Current California RN license. PHN preferred. Current CA Drivers License required. Current BLS certificate required.JOB SUMMARY: Conducts utilization review for in-house patients and those members at contracted facilities. Assists in the discharge planning process.QUALIFICATIONS: Previous experience in an inpatient setting (usually 2 years). Previous experience utilization experience required (usually 1 year). Clinical expert in area of review preferred. Demonstrated knowledge of diagnostic codes.PREFERRED QUALIFICATIONS: Conducts utilization review for in-house patients and those members at contracted facilities. Assists in the discharge Minimum 2 years´ experience within the past five years in an acute medical-surgical setting or skilled level required Minimum 2 years strong QA/UR experience preferred Experience working in chronic disease management and/or with older adult caseload Team leader experience or experience directing the work of others preferred. Excellent clinical assessment and management skills are essential Must demonstrate skills in verbal, written communication, and interpersonal skills. Demonstrated ability to work independently Demonstrated excellent attendance record required. Computer word processing knowledgeDUTIES: Conducts utilization review for in-house patients as well as those members who have admitted to contracted facilities. Conducts clinical reviews based on established treatment criteria. Reviews utilization patterns, identifies trends and problems areas for special studies. Assists other healthcare providers in the discharge planning process and triaging on alternative unit of care. Assists in collecting and assimilating clinical data to enhance the quality of services. Generates quality improvement results. Collaborates with physicians on clinical reviews, keeps them appraised of Kaiser clinical criteria. Reports and investigates unusual occurrences and questions inappropriate decisions based on their professional expertise. Interviews patients/caregivers regarding care after hospitalization. Counsels on Medicare and health care plan coverage. Coordinates referrals to appropriate agencies/facilities.DEPARTMENT SPECIFIC DUTIES:1. Monitors admission of Kaiser patients to contracted skilled nursing facilities and assures that the nursing facility has received all required information and documentation for appropriate care of the patient.2. Facilitates provision of other Kaiser services required for the patient, including physician care, during the patient´s SNF stay and at discharge.3. Tracks patients´ stay in the facility, including services received, medical and functional status and readiness for discharge.4. Authorizes initial and extensions of SNF care in consultation with the SNF physician, based on skilled care criteria, and issues notices of non-coverage to patients/families as described by regulatory agencies.5. Under protocol, gives direction to SNF´s for clinical management of patient problems.6. Maintains SNF charts/CMS/Health Connect with accurate patient data and documents all patient contacts and interventions into CMS.7. Acts as shift supervisor for SNF office staff.Kaiser Permanente conducts compensation reviews of positions on a routine basis. At any time, KaiserPermanente 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. Consistently supports compliance and the Principles of Responsibility (KP´s code of conduct) by maintaining confidentiality, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable Federal and State laws and regulations, accreditation and licensure requirements, and KP policies and procedures. In addition to defined technical requirements, accountable for consistently demonstrating service behaviors and principles defined by the Kaiser Permanente Service Quality Credo, the KP Mission as well as specific departmental/organizational initiatives. Also accountable for consistently demonstrating the knowledge, skills, abilities, and behaviors necessary to provide superiorPLEASE NOTE: - Kaiser Permanente is an AA/EEO employer