Remote Utilization Review Nurse III — Pre-Service

Kaiser Permanente; Spokane (WA); Remoto; USD 91.000 - 105.000; Tempo pieno

Descrizione del lavoro

Kaiser Permanente in Washington state is seeking a Per Diem Utilization Review NURSE III to support medical necessity determinations and discharge planning. The role requires WA/ID mobility and commutable distance to Riverfront Medical Center in Spokane.

The position focuses on consulting with physicians and care teams, applying evidence-based guidelines, and ensuring compliant, cost-effective care while maintaining strong collaboration with members and caregivers.

Competenze

• Bachelors Degree in Nursing AND minimum three (3) years of experience in direct patient care, utilization review/management, or discharge planning in a managed care setting or related field.
• Registered Nurse License (Washington) required at hire OR Compact License: Registered Nurse required at hire
• Two (2) years of experience in utilization review/management preferred

Mansioni

• Pursues effective relationships with others by proactively providing resources, information, advice, and expertise with coworkers and members.
• Completes work autonomously by applying up-to-date expertise to generate creative solutions and ensure procedures are followed.
• Provides high-quality consultation regarding medical necessity and benefit denials across the continuum of care.
• Supports education and compliance initiatives by staying up-to-date with regulations and training staff and physicians.
• Assists in quality improvement by analyzing data, identifying utilization patterns, and implementing corrective action plans.
• Performs utilization reviews by evaluating medical records and treatment plans for medical necessity and appropriateness

Conoscenze

Attention to Detail

Critical Thinking

Communication

Problem Solving

Teamwork

Decision Making

Organizational Savvy

Learning Agility

Formazione

Bachelors Degree in Nursing

RN License (WA)

Descrizione del lavoro

Kaiser Permanente in Washington state is seeking a Per Diem Utilization Review NURSE III to support medical necessity determinations and discharge planning. The role requires WA/ID mobility and commutable distance to Riverfront Medical Center in Spokane.

The position focuses on consulting with physicians and care teams, applying evidence-based guidelines, and ensuring compliant, cost-effective care while maintaining strong collaboration with members and caregivers.