Rn Utilization Review
Kaiser permanente
- Largo
30+ days ago
(20/06/2024)
job description
Job Summary:
The Utilization Review RN is responsible for utilization review, discharge planning and transitions in care, in collaboration with MAPMG rounder in acute or alternative settings of care.
Essential Responsibilities:
- Utilization Review. According to department policy, procedure and protocols, consistently apply and verbally communicate approved utilization review criteria and guidelines for services delivered in acute or alternative care settings.
- Eligibility and Benefit Verification. Confirm eligibility status and ensure the appropriate administration of benefits in accordance with department policies and procedures.
- Assessing Right Venue of Care with Hospitalist. Collaboration with Hospitalist to assess the appropriate level of care for patients (i.E., Medical Unit, Surgical Unit, Tele Unit, TCU, ICU) and post- (Home, Continuum or Community-based Services) hospitalization.
- Coordination of Care. Driving patient care plan through assuring daily plan is executed, and management of transitions and post-hospital care.
- Effective Discharge Planning. Prompt, clinically appropriate discharge planning beginning at time of admission.
- Variance Management. Timely steps in identification of delays in throughput, escalation to correct delays, and recording delays to identify patterns and trends that will require corrective actions.
- Quality Screening. Demonstrate competency to assess all aspects of care across the continuum for variations from quality and utilization standards.
- Performs other related duties as directed.
Basic Qualifications:
Experience
- Minimum one (1) year of experience as an RN in an acute care setting.
Education
- N/A
License, Certification, Registration
- This job requires credentials from multiple states. Credentials from the primary work state are required before hire. Additional Credentials from the secondary work state(s) are required post hire.
- Registered Nurse License (Virginia) within 6 months of hire AND Registered Nurse License (Maryland) within 6 months of hire
OR
- Compact License:
Registered Nurse within 6 months of hire
- Registered Nurse License (District of Columbia) within 6 months of hire
- Basic Life Support
Additional Requirements:
- Annually:
Successful completion of PCC Assessment of Critical Skills. Passing score on inter-rater reliability. - Ability to effectively communicate.
- Ability to conform to established policies and procedures.
- Ability to analytically problem solve and make decisions.
- Ability to tolerate and cope with ambiguity
- Ability to work as a team member.
- Proficiency in the use of applicable computer software.
- Demonstrated ability to effectively and clearly present information through the written word, to influence or persuade others through oral presentation in positive or negative circumstances, and to listen well.
- Demonstrated ability to write clearly, legibly, and effectively, to present ideas and document activities, to read and interpret written information.
Preferred Qualifications:
- Recent acute care, case management, or home health experience preferred.
- B.S.N. preferred.