Utilization Review RN - On Call, Holy Cross Hospital - Silver Spring, MD - Utilization Review
Company: Kaiser Permanente
Location: Silver Spring
Posted on: March 18, 2023
Utilization Review RN - On Call, Holy Cross Hospital - Silver
Spring, MD -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)
- Coordination of Care. Driving patient care plan through
assuring daily plan is executed, and management of transitions and
- 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
- Quality Screening. Demonstrate competency to assess all aspects
of care across the continuum for variations from quality and
- Performs other related duties as directed.
-Case Management experience required. -May have to travel to VHC to
backfill for call outs and vacation.On call working 32 hours per
month as needed. -Weekend and Holiday commitment. - -Basic
- Minimum one (1) year of experience as an RN in an acute care
- N/ALicense, 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
- Registered Nurse License (Maryland) within 6 months of hire AND
Registered Nurse License (Virginia) within 6 months of hire - - - -
- Compact License: Registered Nurse within 6 months of hire
- Registered Nurse License (District of Columbia) within 6 months
- Basic Life Support -Additional Requirements:
- Annually: Successful completion of PCC Assessment of Critical
Skills and 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
- BSN preferred.
Keywords: Kaiser Permanente, Silver Spring , Utilization Review RN - On Call, Holy Cross Hospital - Silver Spring, MD - Utilization Review, Healthcare , Silver Spring, Maryland
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