Quality / Resource Coordinator Registered Nurse - Utilization Management
Quality / Resource Coordinator Registered Nurse - Utilization Management
Job Description
-May be entitled to translation/bilingual, shift or other wage premiums as governed by the applicable collective bargaining agreement. Please refer to the respective collective bargaining agreement for additional information on such wage premiums: https://www.lmpartnership.org/local-contracts.
Job Summary:Provides assessment and monitoring of resource utilization, coordinates outside referrals, provider practice patterns, quality of care, and coordination of our members continuing care needs. Maintain and support a culture of compliance, ethics and integrity. Responsible for ensuring ongoing compliance for the department. Maintains knowledge of policies and procedures and performs in accordance with applicable regulatory requirements, external laws and accreditation standards as they relate to the department.
Essential Responsibilities:
- This position, knows and complies with all Kaiser Permanente quality, safety, and emergency policies and procedures. Demonstrates quality and effectiveness in work habits and clinical practice in every interaction with patients, colleagues, providers, and leadership. Ensures patient safety in the preparation and provisioning of care related to but not limited to medications, procedures, infection prevention, fall prevention, including consistent use of two patient identifiers and procedural time outs. Reports safety hazards, accidents and incidents, and unsafe working conditions promptly.
- Determines and manages appropriate levels of care and services; using clinical knowledge, established guidelines and physician consultation.
- Implements changes in contract benefits, state and federal regulations, and established review criteria guidelines.
- Synthesizes and analyzes a large volume of data related to the member, benefits, eligibility, facilities, contracts, and clinical status to identify issues and facilitate problem solving that results in continuity of care, quality of care and optimal resource management for the patient.
- Coordinates care with various internal and external customers to facilitate high quality, timely, and cost effective care and service.
- Consults and educates other staff, physicians, departments and members regarding resource management options that provide high quality while efficiently using available resources.
Basic Qualifications:Experience
- Three (3) to five (5) years of clinical experience in healthcare setting, experience in utilization review, case management, discharge planning, and managed care.
- High School Diploma or GED
- Registered Nurse License (Colorado)
- N/A
- Three (3) to five (5) years of hospital experience in ICU, CCU, Med/Surg.
- Associates degree in Nursing
Minimum 2 years in hospital RN experience, required.
UM experience preferred.
MCG experience or certification preferred.
Rotating Holidays
-May be entitled to translation/bilingual, shift or other wage premiums as governed by the applicable collective bargaining agreement. Please refer to the respective collective bargaining agreement for additional information on such wage premiums: https://www.lmpartnership.org/local-contracts.
Job Summary:Provides assessment and monitoring of resource utilization, coordinates outside referrals, provider practice patterns, quality of care, and coordination of our members continuing care needs. Maintain and support a culture of compliance, ethics and integrity. Responsible for ensuring ongoing compliance for the department. Maintains knowledge of policies and procedures and performs in accordance with applicable regulatory requirements, external laws and accreditation standards as they relate to the department.
Essential Responsibilities:
- This position, knows and complies with all Kaiser Permanente quality, safety, and emergency policies and procedures. Demonstrates quality and effectiveness in work habits and clinical practice in every interaction with patients, colleagues, providers, and leadership. Ensures patient safety in the preparation and provisioning of care related to but not limited to medications, procedures, infection prevention, fall prevention, including consistent use of two patient identifiers and procedural time outs. Reports safety hazards, accidents and incidents, and unsafe working conditions promptly.
- Determines and manages appropriate levels of care and services; using clinical knowledge, established guidelines and physician consultation.
- Implements changes in contract benefits, state and federal regulations, and established review criteria guidelines.
- Synthesizes and analyzes a large volume of data related to the member, benefits, eligibility, facilities, contracts, and clinical status to identify issues and facilitate problem solving that results in continuity of care, quality of care and optimal resource management for the patient.
- Coordinates care with various internal and external customers to facilitate high quality, timely, and cost effective care and service.
- Consults and educates other staff, physicians, departments and members regarding resource management options that provide high quality while efficiently using available resources.
Basic Qualifications:Experience
- Three (3) to five (5) years of clinical experience in healthcare setting, experience in utilization review, case management, discharge planning, and managed care.
- High School Diploma or GED
- Registered Nurse License (Colorado)
- N/A
- Three (3) to five (5) years of hospital experience in ICU, CCU, Med/Surg.
- Associates degree in Nursing
Minimum 2 years in hospital RN experience, required.
UM experience preferred.
MCG experience or certification preferred.
Rotating Holidays
About Kaiser Permanente
At Kaiser Permanente, we’re all focused on helping people and providing high-quality, affordable health care services and to improve the health of our members and the communities we serve. Across our organization, we’re fiercely committed to our members, our mission, our communities, and each other. We know that each part of the Kaiser Permanente team is essential to our success. Together, we are more than 235,000 dedicated professionals working to advance Kaiser Permanente’s commitment to delivering a healthier tomorrow.
Driven by our collective passion at Kaiser Permanente, we strive to make health care more innovative and compassionate. With the wellness of our patients and our communities at heart, we work to revolutionize health and care from more than 650 locations in 8 states and D.C.
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