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Utilization Review Nurse I
At Kaiser Permanente our nurses are leaders, clinicians, researchers, innovators, and scientists who are contributing toward being an industry-leading voice for advancing evidence-based care. Whether supporting the patient directly in our hospitals or clinics, providing care at home, serving our patients through innovative virtual technology, or managing care delivery teams, Kaiser Permanente nurses utilize scientific evidence and our integrated care model to optimize the total health of our members and the communities we serve. We invite nurses who are passionate about nursing excellence, high-quality compassionate care delivery, professionalism, integrity, teamwork and patient and family centeredness to join our teams so that we can continue to sustain and build upon our culture of excellence.
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Job Schedule: Full-time
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Scheduled Weekly Hours:
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Shift: Day
Success Profile
We’re looking for Nurse Leaders who possess the following traits.
- Collaborative
- Compassionate
- Flexible
- Leadership
- Socially Conscientious
- Trustworthy
Benefits
We offer several benefits to our nurses.
Our Culture
At Kaiser Permanente, we cultivate an environment of compassion, integrity, trust, and open communication that helps our teams do their best work. We believe that lifelong learning will expand our knowledge so we can better serve our patients. Our practice is rooted in research and evidence-based care. Our nurses reflect the rich diversity of our members and communities and provide culturally responsive and competent care that promotes understanding of our members needs and preferences. At Kaiser Permanente, nurses are highly skilled professionals who exemplify leadership, critical thinking, and collaborative problem solving and deliver the right care, at the right time, in the right setting.
Hear From Our People
Caitlin
Inpatient Lactation Consultant
As an RN/IBCLC in Maternal Child, I’m meeting families at a pivotal time — I’m there to help launch a new family into the world. Everything I do has the potential to impact a family’s health for generations to come.
Kimberly
Quality Coordinator RN
In Hawaii, your community is your family — or ‘ohana.’ I am able to provide extraordinary patient-centered care to my ohana.
David
Appointment and Advice RN
The location is fantastic. Kaiser Permanente is all over the country. You can pick almost any environment you want — from ocean to mountain to city. You’ll still be able to contribute to our mission of providing high quality health care at a local facility.
Shawn
BSN, RN
I chose Kaiser Permanente because their staff and providers really show that they care about you. Also, throughout my 12 years of working here I’m always learning something new, and I’ve had many opportunities for growth and development.
Kristen
Relief Charge Nurse
Working as a nurse at Kaiser Permanente has allowed me the perfect flexible schedule so that I can volunteer as Girl Scout Leader and room parent for both my children. My kids know that I am a hardworking mother who can provide, as well as a mom who can be present and be there for them – and that means everything to me.
Jazmin
RN, Advice Nurse
Working for Kaiser Permanente has allowed me to take control of my future and make my goals a possibility. I feel that Kaiser Permanente allows me to keep climbing and moving. Having that ability truly makes me feel empowered.
Utilization Review Nurse I
In addition to the responsibilities listed below, this position is also responsible for leveraging clinical knowledge of evidence-based guidelines, insurance policies, and clinical criteria to consult on the medical necessity, level of care, and duration of treatment required for basic reviews, and collaborating with the health care team, members, and caregivers to assist in discharge planning, cost of care options, and/or coordinating referrals to appropriate services based on medical necessity.
- Pursues effective relationships with others by sharing information with coworkers and members. Listens to and addresses performance feedback. Pursues self-development; acknowledges strengths and weaknesses, and takes action. Adapts to and learns from change, challenges, and feedback. Responds to the needs of others to support a business outcome.
- Completes routine work assignments by following procedures and policies and using data, and resources with oversight and management. Collaborates with others to address business problems; escalates issues or risks as appropriate; communicates progress and information. Adheres to established priorities, deadlines, and expectations. Identifies and speaks up for improvement opportunities.
- Supports high-quality consultation by: communicating with physicians, managers, staff, members, and/or caregivers regarding requirements related to medical necessity and benefit denials across the continuum of care, under direct supervision; and leveraging working knowledge to ensure the correct and consistent application, interpretation, and utilization of member health care benefits, cost of care options, and coverage by members and physicians.
- Supports education and compliance initiatives by: remaining up-to-date and discussing with the team the relevant state and federal regulations, guidelines, criteria, and documentation requirements that affect utilization management; and participating in education and training programs for staff and physicians at the local level to promote best practices in utilization management.
- Assists in quality improvement efforts by: observing and escalating utilization patterns, trends, and opportunities for improvement; learning about utilization review workflows/processes including corrective action plans and standard work, and identifying deficiencies in workflows; and learning and actively adhering to utilization policies, procedures, and guidelines to ensure compliant and cost-effective care.
- Performs utilization reviews by: following standard policies and procedures when conducting reviews of medical records and treatment plans to evaluate the medical necessity, appropriateness, and efficiency of requested health care services, under direct supervision; and beginning to assess the ongoing need for services, identifying potential issues/delays, and recommending appropriate actions for standard member cases.
- Ambiguity/Uncertainty Management
- Attention to Detail
- Business Knowledge
- Communication
- Critical Thinking
- Cross-Group Collaboration
- Decision Making
- Dependability
- Diversity, Equity, and Inclusion Support
- Drives Results
- Facilitation Skills
- Health Care Industry
- Influencing Others
- Integrity
- Learning Agility
- Organizational Savvy
- Problem Solving
- Short- and Long-term Learning & Recall
- Teamwork
- Topic-Specific Communication
- Medical Terminology
- Nursing Principles
- Acts with Compassion
- Confidentiality
- Consulting
- Evidence-Based Medicine Principles
- Quality Assurance and Effectiveness
- Relationship Building
- Written Communication
- Associates Degree in Nursing.
- Registered Nurse License (Hawaii) required at hire
- Basic Life Support required at hire
- N/A
Navigating the Hiring Process
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Industry Leader
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Ranked among the nation's best
Every hospital that's part of the Kaiser Permanente system earned “high performing” recognition in the latest U.S. News and World Report's annual rankings. That means all 39 of our hospitals are among the top 20% in the nation.
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Awarded for excellence
We're proud that so many of our hospitals have earned Magnet status. It shows our real commitment to outcomes, safety, quality, efficiency, and, most importantly, to our nurses.
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Recognizing nurses during Nurses Month in 2022
We're thanking each one of our 65,000 Kaiser Permanente nurses for everything they've done for us and for the nation. Thank you for choosing to be a nurse and for leading our transformation of care.
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Explore a career in nursing
When you join Kaiser Permanente as a nurse, you'll help us boldly transform care while also building a career that offers more opportunities for you to grow.
Experience nursing excellence
At Kaiser Permanente our nurses are leaders, clinicians, researchers, innovators, scientists, and more. It takes an extraordinary team to offer extraordinary care.
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