Employer:Kaiser Permanente
Posted:2009-12-31
Location:Silver Spring, Maryland
Category:Registered Nurse (RN)
Job Type:On Call

Job Description

Schedule: Temporary position from 01/01/2010-12/31/2010. On-Call position to include Monday - Friday within the hours of 8:30AM - 5:00PM.

POSITION TITLE: Coordinator, MD Telephonic Patient Care

PURPOSE:
Responsible for initiating and consistently evaluating the medical necessity and appropriateness of members/patients level of care; maintaining efficiency and integrity of the referral process and to monitor the quality of outcomes for the patient and the health plan.

"This position consistently supports compliance and Kaiser Permanente's Code of Conduct by adhering to federal, state and local laws and regulations, accreditation and licenser requirements and Kaiser Permanente's policies and procedures."

ACCOUNTABILITIES: (List of 4 - 6 primary responsibilities, not activities, in their order of importance)
1. Maintains the data integrity and authorization process of the referral system
2. Provides urgent/emergent care management, utilization and referral management for members/patients in the ED or other outpatient/preadmission settings.
3. Interacts with physicians to influence actions and decision in cases where a physician needs assistance to expeditiously transition a member/patient to the appropriate level of care
4. Initiates the denial letter process in accordance with Kaiser Permanente, state and federal regulations.
5. Works with physician to coordinate repatriation of both In and Out of Area members transferring from one facility to another.
6. Coordinates transport by ambulance for members transferring from one facility to another in accordance with Health Plan policies and procedure
7. Provides case management services
8. Provides utilization management services
9. Provides quality screening
10. Coordinates communication and promotes collaboration between the disciplines providing care or case management within the Kaiser Permanente system
11. Performs other related duties as directed

MINIMUM REQUIREMENTS -
Relevant Years of Experience:
Three years of clinical experience with two years of utilization management experience
Experience with computer software programs in a Windows environment

Education and/or Classes:
· BS preferred

License, Certification and/or Designation:
· RN license in jurisdiction where assigned

Essential Functions (i.e. bending, lifting, and mobility):
See Functional & Environmental Evaluation (FEE) Form.

Kaiser Permanente's Service Standards:
· We are Kaiser Permanente - Dedicated Professionals.
· We value and appreciate each other.
· We make eye contact and display appropriate body language (E.G., Smile)
· We keep our promise and commitment to excellence.
· We promote wellness and living well.
· We address our members' concerns and their unique needs.
· We provide immediate service recovery.
· We treat each person with respect and dignity.
· We speak and listen with empathy.
· We thank each and every member for choosing Kaiser Permanente.

The critical skills needed to perform this job are:
Ability to effectively communicate
Ability to conform to established policies and procedures
Ability to analytically problem solve and make decisions
Ability to tolerate and cope with ambiguity
Ability to work as a team member
Proficiency in the use of applicable computer software

Click here to view our ER nurse jobs.
Click here to post your resume for the quickest response.