Remote Utilization Review RN – Doctor’s Community Hospital, MD

Kaiser Permanente

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Primary Location Lanham-Seabrook, Maryland
Job Number 1195006

Description:

Job Summary:

 

The Utilization Review RN is responsible for utilization review, discharge planning and transitions in care, in collaboration with MAPMG rounder in acute or alternative settings of care.

Essential Responsibilities:

 

    • Utilization Review. According to department policy, procedure and protocols, consistently apply and verbally communicate approved utilization review criteria and guidelines for services delivered in acute or alternative care settings.

 

    • Eligibility and Benefit Verification. Confirm eligibility status and ensure the appropriate administration of benefits in accordance with department policies and procedures.

 

    • Assessing Right Venue of Care with Hospitalist. Collaboration with Hospitalist to assess the appropriate level of care for patients (i.e., Medical Unit, Surgical Unit, Tele Unit, TCU, ICU) and post- (Home, Continuum or Community-based Services) hospitalization.

 

    • Coordination of Care. Driving patient care plan through assuring daily plan is executed, and management of transitions and post-hospital care.

 

    • Effective Discharge Planning. Prompt, clinically appropriate discharge planning beginning at time of admission.

 

    • Variance Management. Timely steps in identification of delays in throughput, escalation to correct delays, and recording delays to identify patterns and trends that will require corrective actions.

 

    • Quality Screening. Demonstrate competency to assess all aspects of care across the continuum for variations from quality and utilization standards.

 

    • Performs other related duties as directed.

 

Every other Weekend and Holiday.
Case management experience preferred.Maybe required to support other facilities remotely.
Basic Qualifications:
Experience
  • Minimum one (1) year of experience as an RN in an acute care setting.
Education
  • N/A
License, Certification, Registration
  • This job requires credentials from multiple states. Credentials from the primary work state are required before hire. Additional Credentials from the secondary work state(s) are required post hire.
  • Registered Nurse License (Virginia) within 6 months of hire AND Registered Nurse License (Maryland) within 6 months of hire

OR

  • Compact License: Registered Nurse within 6 months of hire
  • Registered Nurse License (District of Columbia) within 6 months of hire
  • Basic Life Support
Additional Requirements:
  • Annually: Successful completion of PCC Assessment of Critical Skills. Passing score on inter-rater reliability.
  • 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.
  • Demonstrated ability to effectively and clearly present information through the written word, to influence or persuade others through oral presentation in positive or negative circumstances, and to listen well.
  • Demonstrated ability to write clearly, legibly, and effectively, to present ideas and document activities, to read and interpret written information.
Preferred Qualifications:
  • Recent acute care, case management, or home health experience preferred.
  • B.S.N. preferred.

Primary Location: Maryland,Lanham,Doctors Community Hospital 8200 Good Luck Rd..
Scheduled Weekly Hours: 40
Shift: Day
Workdays: Mon, Tue, Wed, Thu, Fri, Sat, Sun
Working Hours Start: 08:30 AM
Working Hours End: 05:00 PM
Job Schedule: Full-time
Job Type: Standard
Employee Status: Regular
Employee Group/Union Affiliation: M38|UFCW|Local 400
Job Level: Individual Contributor
Department: Doctors Community Hospital – UR-Discharge Planning – 1808
Pay Range: $43.67 – $48.93 / hour
The ranges posted above reflect the location in the job posting. The salary range may vary if you reside in a different location or state than the location posted.
Travel: No