DEPARTMENT:  Continuing Care SNF

SCHEDULE:  On-Call, 0 hours per week, Day shift. Weekend coverage may be required. 

EDUCATION:  BSN or BA in health care related field preferred. Graduate of accredited school of nursing.

LICENSE/CERTIFICATION:   Current California RN license. PHN preferred.

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: BSN or BA in Health Care Field required. Current BLS Certificate. Current RN, Current California Driver's License.  Must be able to provide comprehensive assessments.  Must have excellent clinical skills and be able to work independently.  Three of the past five years should be either acute or ambulatory adult internal medicine or SNF.  Recent Geriatric/Rehab experience desirable.  Knowledge of Medicare SNF regulations and Kaiser Health Plan Benefits required.  Must have a valid and current CA Driver’s License and Insurance.  Must be service oriented and an excellent communicator.  Able to work as part of a multidisciplinary team.  Ability to facilitate communications between vendors, a variety of disciplines, departments and patients.  Must have computer experience and be able to navigate Windows.  Must be able to type visit notes in Lotus Notes/CMS.

SKILLS:  N/A

DUTIES:  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 health care 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.

OTHER DUTIES:  Conducts utilization review for SNF patients. Assists SNFs in discharge planning process.  Participates in quality improvement activities. Collaborates with physicians and NPs on clinical reviews, keeps them appraised of clinical criteria.  Provides guidance on Medicare and Health Plan coverage.  Participates as a SNF representative on committees and task forces.  Other duties as requires. 

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.

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 superior and culturally sensitive service to each other, to our members, and to purchasers, contracted providers and vendors.

PLEASE NOTE: - Kaiser Permanente is an AA/EEO employer -