Senior Clinical Navigator - Utilization & Care Coordination

Kaiser Permanente; Renton (WA); On-site; USD 192,000 - 222,000; Full time

Job summary

Kaiser Permanente in Renton, Washington, seeks a Clinical Navigator - Senior Utilization Review Nurse II to join population health and care outcomes teams. This role blends quality improvement, utilization review, and health equity, partnering with clinicians and leaders to close care gaps and optimize outcomes.

The ideal candidate uses data analytics, care coordination, and evidence-based guidelines to assess medical necessity, coordinate discharge planning, and advance cost-effective care.

Qualifications

• Bachelor of Nursing and RN license required or eligible for WA/Compact license.
• Minimum seven (7) years in direct patient care, UR/management or discharge planning in managed care.
• Minimum three (3) years in a leadership role.

Responsibilities

• Lead cross-functional teams to improve utilization review processes.
• Oversee complex data analyses to identify utilization patterns and opportunities.
• Consult on medical necessity and benefit determinations for complex cases.
• Develop and implement education and training for staff on utilization management.
• Drive quality improvement initiatives and monitor corrective action plans.
• Ensure adherence to policies and guidelines for cost-effective care.

Skills

Nursing leadership

Utilization review

Discharge planning

Communication

Problem solving

Team collaboration

Quality improvement

Data analysis

Education

Bachelor of Nursing

WA RN License or Compact

Tools

EMR/EHR

Medical terminology

Job description

Kaiser Permanente in Renton, Washington, seeks a Clinical Navigator - Senior Utilization Review Nurse II to join population health and care outcomes teams. This role blends quality improvement, utilization review, and health equity, partnering with clinicians and leaders to close care gaps and optimize outcomes.

The ideal candidate uses data analytics, care coordination, and evidence-based guidelines to assess medical necessity, coordinate discharge planning, and advance cost-effective care.