Utilization Review Manager - Home Care jobs in San Jose, CA

Conducts utilization review for in-house patients and/or those members at contracted facilities. Assists in the discharge planning process.

• Conducts utilization review for in-house patients and/or members who have been admitted to contracted facilities. Interviews patients/caregivers regarding care after hospitalization.
• Conducts clinical reviews based on established treatment criteria.
• Collaborates with physicians on clinical reviews, keeps them appraised of Kaiser clinical criteria.
• Reviews utilization patterns, identifies trends and problems areas for special studies.
• Assists in collecting and assimilating clinical data to enhance the quality of services.
• Generates quality improvement results.
• Reports and investigates unusual occurrences and questions inappropriate decisions based on their professional expertise.
• Assists other health care providers in the discharge planning process and triaging on alternative unit of care.
• Counsels on Medicare and health care plan coverage.
• Coordinates referrals to appropriate agencies/facilities.
• Kaiser Permanente conducts compensation reviews of positions on a routine basis.  At any time, Kaiser Permanente reserves the right to reevaluate and change job descriptions, or to change such positions from salaried to hourly pay status.  Such changes are generally implemented only after notice is given to affected employees.