Pre-Service Clinical Review Nurse (Per Diem) Must Live in WA or ID

About the job

Kaiser Permanente is hiring a per diem pre-service clinical review nurse, a utilization review nurse who decides whether requested care is medically necessary before it happens. Applicants must live in Washington or Idaho within commuting distance of Kaiser Permanente Washington Medical Center.

What you'll do

• Review medical records and treatment plans to judge whether requested services are medically necessary, appropriate and efficient
• Use clinical criteria, insurance policies and evidence-based guidelines to decide the level and length of care in moderately complex reviews
• Help the care team, members and caregivers with discharge planning, cost of care options and referrals
• Explain medical necessity requirements and benefit denials to physicians, managers, staff and members
• Keep current on state and federal utilization management rules and help train staff and physicians
• Analyze utilization data, write reports and help fix gaps in review workflows
• Mentor teammates and work on your own on assignments, raising issues or delays when needed

What you need

• Must live in Washington or Idaho within commuting distance of Kaiser Permanente Washington Medical Center

Preferred

• Prior work experience as an RN in utilization review or utilization management (highly preferred)

Schedule

• Per diem
• Available Mon to Sun, 8am to 5pm