At Kaiser Permanente, we value the rich diversity of our organization and aspire always to demonstrate respect for the uniqueness of each individual.
We encourage each contribution to the establishment of an open, inclusive environment that supports and empowers our employees.
INTERNAL POSTING PERIOD: 11/05/09-11/09/09
IF YOU ARE A COLORADO INTERNAL EMPLOYEE, YOU MUST PLACE YOUR BID ON THE BID LINE 303-614-1510, NOT
ONLINE.
PREFERRED SKILLS: 3-5 years clinical experience in hospital setting, preferably ICU, CCU, Med-Surg.
Experience in utilization review, case management, discharge planning & managed care. Knowledge &
experience with Medicare coverage guidelines & medical criteria such as Interqual or Milliman &
Robertson. Knowledge of quality & utilization review methods, statistical techniques, utilization
management compliance standards & regulatory elements. Effective interpersonal communication,
critical thinking 7 negotiating skills. Moderate proficiency in Microsoft Word & Excel.
JOB SUMMARY: Provides assessment and monitoring of resource utilization, coordinates outside
referrals, provider practice patterns, quality of care, and coordination of our members continuing
care needs. Maintain and support a culture of compliance, ethics and integrity. Responsible for
ensuring ongoing compliance for the department. Maintains knowledge of policies and procedures and
performs in accordance with applicable regulatory requirements, external laws and accreditation
standards as they relate to the department.
POSITION REQUIREMENTS: Current unrestricted license as a Registered Nurse in the State of Colorado.
Three to five years clinical experience in hospital setting, preferably ICU, CCU, Med-Surg.
Experience in utilization review, case management, discharge planning, and managed care. Knowledge
and experience with Medicare coverage guidelines and medical criteria such as Interqual or Milliman
and Robertson. Knowledge of quality and utilization review methods, statistical techniques,
utilization management compliance standards, and regulatory elements. Effective interpersonal,
communication, and negotiating skills.
ESSENTIAL RESPONSIBILITIES: Determines and manages appropriate levels of care and services; using
clinical knowledge, established guidelines, and physician consultation.
Implements changes in contract benefits, state and federal regulations, and established review
criteria guidelines.
Synthesizes and analyzes a large volume of data related to the member, benefits, eligibility,
facilities, contracts, and clinical status to identify issues and facilitate problem solving that
results in continuity of care, quality of care and optimal resource management for the patient.
Coordinates care with various internal and external customers to facilitate high quality, timely,
and cost effective care and service.
Consults and educates other staff, physicians, departments and members regarding resource management
options that provide high quality while efficiently using available resources.
For Essential Responsibilities: 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.
Functional and Environmental Factors available upon request.
SCHEDULE: Variable Hours Monday - Friday; Occasional PM and Weekend hours.
STARTING SALARY RANGE: $4,864 - $6,205 (Monthly)
- Kaiser Permanente is an AA/EEO employer -
Variable Hours and may need to float to other locations.
