Occupational Health RN Coordinator- Pasadena - FT

Company: Kaiser
Location: Pasadena
Posted on: November 25, 2022

Job Description:

For the Southern California Occupational Health Services/Employee Health Services and in collaboration with the OHS Program Administrator: plans, designs, conducts, and evaluates/improves utilization, quality, and outcomes/performance management/improvement programs in order to comply with and meet all regulatory requirements, as well as organizational and SCPMG standards and requirements. This position is accountable for quality, utilization, outcomes management/improvement, regulatory compliance and practice standards for OHS and EHS programs and services. Also accountable for the design and evaluation of education/training and staff development courses, modules and/or programs to maintain and enhance staff competencies in the areas of practice standards, quality, utilization, service delivery and outcomes/performance management.
Essential Responsibilities:

• Plans, develops and implements quality and utilization management, clinical outcomes management and performance improvement programs and standards for OHS/EHS programs and services throughout the Southern California Region
• Designs and utilizes methods, systems and processes to evaluate and improve the quality of services /programs, utilization of resources and clinical/performance outcomes In collaboration with QA and UR Departments, maintains, monitors and continuously improves OHS Quality Assurance and Utilization Review programs
• Maintains, monitors and continuously improves QA and UR programs for Occupational Health Safety Services and Disability case management programs/services Maintains and monitors standardized OHS clinical practice throughout the Southern California region
• Produces productivity and utilization metrics that assist Service Areas in monitoring and maintaining clinical practice standards and activities
• Collaborates with Patient Business Services and Northern California OHS to facilitate and establish consistent service reporting and billing
• Monitors on-going OHS/EHS clinical programs/services/activities, including medical/nursing activities associated with billing and training
• Manages the identification and resolution of issues involving OHS clinical performance and clinical practice standards
• Works with Service Area OHS managers and personnel to implement corrective/improvement plans and follows up on post-implementation status
• Collaborates with Regional OHS Workers Compensation Analyst(s) and OHS Manager(s) to assess clinical training needs and develops/evaluates staff development/ training / education plans and programs for OHS staff in local Service Areas
• Coordinates OHS clinical practice policy/procedures and decisions with appropriate SCPMG and Service Area leaders
• May perform other related duties as requiredBasic Qualifications:Experience

• Minimum three (3) years of relevant experience -required in California Workers Compensation and Disability claims administration and case management for employers, carriers and third party administratorsEducation
  • Graduate of an accredited school of nursing required
  • Bachelor's degree in nursing, health services, public administration or related field required. License, Certification, Registration
    • Current and valid California RN License.
    • Certified Case Manager Certification (CCM) Additional Requirements:
      • Ability to demonstrate knowledge of and to utilize /apply California Workers' Compensation laws and the methods/processes and practices of case management and outcomes management
      • Demonstrated ability to assess and critically analyze clinical training needs and design/evaluate staff development/education/training programs and/or modules
      • Demonstrated ability to utilize facilitation, problem solving, negotiating, influencing, communication, customer service, time and self management skills, as well as basic computer software ( e.g., Windows -)
      • Must be able to work in a Labor/Management Partnership environmentPreferred Qualifications:
        • Three (3) years Quality Review/Audit reporting and URAC (Utilization Review Accreditation Commission)
        • Ability to demonstrate knowledge of occupational medicine delivery systems within a managed care environment preferred
        • Previous experience developing and evaluating train-the-trainer programs preferred
        • WC and Employee Health Experience preferred. Job Schedule: Job Category: Nursing Licensed & Nurse Practitioners

Keywords: Kaiser, Pasadena , Occupational Health RN Coordinator- Pasadena - FT, Healthcare , Pasadena, California