Utilization Review Nurse II: Care Coordination & Compliance

Kaiser Permanente; Baldwin Park (CA); On-site; USD 90,000 - 120,000; Full time

Job summary

Kaiser Permanente in California seeks a Registered Nurse with utilization review experience to consult on medical necessity and level of care across the care continuum. You will collaborate with physicians, managers, and care teams to optimize discharge planning and cost-of-care options.

The role emphasizes evidence-based practice, adherence to guidelines, and ongoing participation in education programs for staff and physicians within the local utilization management framework.

Qualifications

• Bachelors Degree in Nursing and CA RN license required.
• Minimum one year of experience in direct patient care, utilization review/management, or discharge planning.
• Experience in managed care setting preferred.

Responsibilities

• Build effective relationships by sharing resources and knowledge with coworkers and members; respond to feedback.
• Complete work by using current subject knowledge to meet deadlines and follow procedures.
• Consult on medical necessity and benefit denials across the continuum of care with physicians, managers, staff, members, and caregivers.
• Support education by staying up-to-date with state and federal regulations and participating in training programs.
• Contribute to quality improvement by identifying utilization patterns and opportunities for improvement.
• Perform utilization reviews by following policies to evaluate medical necessity and efficiency of services.

Skills

Communication

Critical Thinking

Problem Solving

Teamwork

Decision Making

Health Care Industry

Education

Bachelor's Degree in Nursing

RN License (California)

Job description

Kaiser Permanente in California seeks a Registered Nurse with utilization review experience to consult on medical necessity and level of care across the care continuum. You will collaborate with physicians, managers, and care teams to optimize discharge planning and cost-of-care options.

The role emphasizes evidence-based practice, adherence to guidelines, and ongoing participation in education programs for staff and physicians within the local utilization management framework.