Job Summary :
Coordinates quality, utilization and risk management activities for the Home Care Agency; provides technical, educational, consultative, and coordinating support to assigned areas.
Essential Responsibilities :
- Assists in the coordination of the quality management / utilization management department activities. Acts as a consultant for appropriate departments on quality management, utilization management and risk management activities.
- Assists with quality management studies through data collection, data input and report development. Provides objective assessment of important aspects of patient care through ongoing chart review with pre-established criteria.
- Facilitates interdisciplinary collaboration for development of patient care paths. Reports all occurrences which may lead to medical center liability and follows up as necessary.
- Serves as a member of the QM and / or UM Committees as needed. Attends and / or participates in committee meetings as needed.
Assists in orientation and training; in formulating and evaluating policies and procedures.
- Performs special projects as assigned, such as statistical reports for state, federal, and local agencies. Assists the director of quality and utilization management for QM and UM in the formulation of department goals and objectives.
- 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.
Basic Qualifications :
Experience
Minimum three (3) years of home care nursing experience or quality utilization review experience.
Education
- Bachelors degree in nursing or related field OR four (4) years of experience in a directly related field.
- High School Diploma or General Education Development (GED) required.
License, Certification, Registration
Registered Nurse License (California)
Additional Requirements :
- Current working knowledge of The Joint Commission, NCQA and Title 22 and federal standards / regulations.
- Strong problem solving, project management, group facilitation and teamwork skills.
- Demonstrate knowledge of adult learning theories.
- Demonstrate ability to assess or evaluate patient medical records as it relates to quality of care and systems analysis.
- Demonstrate knowledge of quality improvement, statistical analysis, and accreditation and licensing processes.
- Must be able to work in a Labor / Management Partnership environment.
Preferred Qualifications :
- Supervisory experience preferred.
- Valid CA drivers license with personal means of transportation preferred.
- PC literate, Microsoft Office applications preferred.
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