Kaiser Permanenteposted about 1 month ago
Modesto, CA
Religious, Grantmaking, Civic, Professional, and Similar Organizations
About the position
The position involves conducting utilization reviews for in-house patients and members at contracted facilities, as well as assisting in the discharge planning process. The role requires collaboration with healthcare providers and physicians to ensure quality care and adherence to established treatment criteria.
Responsibilities
- Conducts utilization review for in-house patients and/or members who have been admitted to contracted facilities.
- Interviews patients/caregivers regarding care after hospitalization.
- Conducts clinical reviews based on established treatment criteria.
- Collaborates with physicians on clinical reviews, keeping them appraised of Kaiser clinical criteria.
- Reviews utilization patterns, identifies trends and problem areas for special studies.
- Assists in collecting and assimilating clinical data to enhance the quality of services.
- Generates quality improvement results.
- Reports and investigates unusual occurrences and questions inappropriate decisions based on their professional expertise.
- Assists other health care providers in the discharge planning process and triaging on alternative unit of care.
- Counsels on Medicare and health care plan coverage.
- Coordinates referrals to appropriate agencies/facilities.
