Quality/Resource Coordinator Behavioral Health
Company Name:
Kaiser Permanente
Provides assessment and monitoring of resource utilization, coordinates outside referrals, provider practice patterns, quality of care and coordination of our members continuing care needs. Maintain sand supports a culture of compliance, ethics and integrity. Responsible for ensuring ongoing compliance for the department. Maintains knowledge of policies and procedures and performs in accordance w/applicable regulatory requirements, external laws and accreditation standards as they relate to the department.
Essential Functions: - Determines and manages appropriate levels of care and services using clinical knowledge, established guidelines and physician consultation. - Implements changes in contract benefits, state and federal regulations and established review criteria guidelines. - Synthesizes and analyzes a large volume of data related to the member, benefits, eligibility, facilities, contracts and clinical status to identify issues and facilitate problem solving that results in continuity of care, quality of care and optimal resource management for the patient. - Coordinates care with various internal and external customers to facilitate high quality, timely and cost effective care and service. - Consults and educates other staff, physicians, departments and members regarding resource management options that provide high quality while efficiently using available resources. - Must have flexibility to travel when needed to treatment facilities and Behavioral Health and Resource Stewardship meetings.
Qualifications: Basic
Qualifications: Experience - Minimum three (3) years of clinical experience in hospital setting, preferably psychiatric hospital. - Experience in utilization review, case management, discharge planning and managed care required. Education - Master's degree WITH two (2) years post master's experience under appropriate supervision OR currently licensed as an RN License, Certification, Registration - Colorado licensure as a Licensed Clinical Social Worker OR current unrestricted license as an RN in the State of Colorado. Additional Requirements: - Knowledge and experience with Medicare coverage guidelines and medical criteria such as Interqual or Milliman and Robertson. - Knowledge of quality and utilization review methods, statistical techniques, utilization management compliance standards and regulatory elements. - Effective interpersonal, communication and negotiating skills. Preferred
Qualifications: - Prefer additional clinical experience in other behavioral health settings such as outpatient, day or residential treatment, addiction medicine and medical hospital consultation. - Prefer experience in more than one age group, e.g., child, adolescent, adult, geriatric. - BSN preferred. - Familiarity with electronic medical record and spreadsheet and/or database programs preferred. - Behavioral Health Utilization Management / Case Management preferred. Prefer Behavioral Health experience within 5 years.
REQNUMBER: 276705
JOBCOMPANY: Kaiser Permanente
JOBLOCATION: Denver, COEstimated Salary: $20 to $28 per hour based on qualifications.
Kaiser Permanente
Provides assessment and monitoring of resource utilization, coordinates outside referrals, provider practice patterns, quality of care and coordination of our members continuing care needs. Maintain sand supports a culture of compliance, ethics and integrity. Responsible for ensuring ongoing compliance for the department. Maintains knowledge of policies and procedures and performs in accordance w/applicable regulatory requirements, external laws and accreditation standards as they relate to the department.
Essential Functions: - Determines and manages appropriate levels of care and services using clinical knowledge, established guidelines and physician consultation. - Implements changes in contract benefits, state and federal regulations and established review criteria guidelines. - Synthesizes and analyzes a large volume of data related to the member, benefits, eligibility, facilities, contracts and clinical status to identify issues and facilitate problem solving that results in continuity of care, quality of care and optimal resource management for the patient. - Coordinates care with various internal and external customers to facilitate high quality, timely and cost effective care and service. - Consults and educates other staff, physicians, departments and members regarding resource management options that provide high quality while efficiently using available resources. - Must have flexibility to travel when needed to treatment facilities and Behavioral Health and Resource Stewardship meetings.
Qualifications: Basic
Qualifications: Experience - Minimum three (3) years of clinical experience in hospital setting, preferably psychiatric hospital. - Experience in utilization review, case management, discharge planning and managed care required. Education - Master's degree WITH two (2) years post master's experience under appropriate supervision OR currently licensed as an RN License, Certification, Registration - Colorado licensure as a Licensed Clinical Social Worker OR current unrestricted license as an RN in the State of Colorado. Additional Requirements: - Knowledge and experience with Medicare coverage guidelines and medical criteria such as Interqual or Milliman and Robertson. - Knowledge of quality and utilization review methods, statistical techniques, utilization management compliance standards and regulatory elements. - Effective interpersonal, communication and negotiating skills. Preferred
Qualifications: - Prefer additional clinical experience in other behavioral health settings such as outpatient, day or residential treatment, addiction medicine and medical hospital consultation. - Prefer experience in more than one age group, e.g., child, adolescent, adult, geriatric. - BSN preferred. - Familiarity with electronic medical record and spreadsheet and/or database programs preferred. - Behavioral Health Utilization Management / Case Management preferred. Prefer Behavioral Health experience within 5 years.
REQNUMBER: 276705
JOBCOMPANY: Kaiser Permanente
JOBLOCATION: Denver, COEstimated Salary: $20 to $28 per hour based on qualifications.
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