Under indirect supervision, promotes & facilitates appropriate utilization of services of Kaiser patients through implementation of various measures. Reviews medical record to insure that services provided to patients are medically necessary, delivered in most appropriate setting & meets professionally accepted standards of quality; identifies problems in utilization & quality & makes recommendations for their correction. Initiates discharge planning process. Collaborates with physicians, nursing, medical social services, patients, families, & outside agencies. Facilitates efficient & timely transition in hospital course from pre-admission, through hospital to post-hospital destination for all inpatients. Specializes in identifying & assessing patients in need of post-hospitalization care. Develops, documents, & implements discharge plans promoting use of alternative care options & community resources as necessary; assures hospitalized patient's continuing care needs are met adequately in cost-effective manner without compromising quality of care or quality of service. Coordinates and/or establishes various discharge protocols for Kaiser Foundation Hospitals.
Essential Functions:
Performs chart reviews & ensures appropriate utilization of inpatient beds by evaluating current status of patients, by determining level of care, & if necessary, changes in diagnosis or treatment plans & medical necessity & appropriateness of admission & continued stay working in conjunction with Utilization Management (UM) Physician Advisor
Issues denial of service letters after conferring with physicians
Assesses patient data for appropriateness of continued stay benefits when directed
Performs pre-admission reviews of patients being admitted to hospital, Short Stay Unit & Skilled Nursing Facility as assigned by supervisor; intervenes when admission criteria is not met & pursues alternatives to avoid inappropriate admission by utilizing alternative care resources
Collaborates with UM Physician/UM Chairman, Hospital Administrator & Director of Nursing to identify & assists in resolving occurrences that cause unnecessary admission & /or unnecessary hospital days as directed by Supervisor
Consults with supervisor, Utilization Management, Physician Advisors, peers & other staff in Continuing Care Department on problem cases
Interprets & explains hospital policies/procedures as needed to patients, families, & significant others
Establishes discharge plan after assessment & recommends appropriate treatment & follow-up care based on sound pathophysiological rationale; understands medical care regimen & interacts actively with physicians & nursing staff to review discharge plans
Uses RN clinical expertise & experience on medical care & technology to adjust discharge plan commensurate with patients' physical or functional deficits
Coordinates patient care conferences & discharge planning rounds on Nursing Units to review discharge plans & facilitate discharge process
Understands Kaiser's Continuous Quality Improvement Program & Acts as role model by being service-oriented to internal & external customers
Performs other duties & accepts responsibility as assigned
Additional essential functions as listed in the complete job description
Basic Qualifications:
Two years acute care nursing experience including discharge planning
Bachelor's degree in nursing.
Valid Hawaii RN license (must meet education requirement(s) for Hawaii State licensure)
Current BLS for Healthcare Provider CPR or CPR/AED for the Professional Rescuer certification
Demonstrated knowledge of and skill in change management, decision making, customer service, influence, interpersonal relations, oral communication, problem solving, quality management, team building, teamwork, written communication
Talking to co-workers, customers, outside vendors, & on the telephone
Reading, writing, speaking and understanding English
Training/giving and receiving instructions
Mathematical ability, attention to detail (e.g. organization, prioritization, proofing), concentration and alertness
Preferred Qualifications:
Utilization review experience in managed care setting
Demonstrated knowledge of and skill in word processing, spreadsheet, and database PC applications
