ZipRecruiter

Log In

1

Kaiser Utilization Management Jobs in Hawaii (NOW HIRING)

Kaiser Permanente

Charge Nurse - NICU Unit

Honolulu, HI · On-site

$76.99/hr

Population Management: Certified Diabetes Educator (CDE) by the National Certification Board for ... Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive ...

next page

Showing results 1-20

All JobsKaiser Utilization Management JobsKaiser Utilization Management Jobs in Hawaii

Kaiser Utilization Management information

What is Kaiser Utilization Management?

Kaiser Utilization Management refers to the process within Kaiser Permanente that evaluates the necessity, appropriateness, and efficiency of healthcare services provided to members. Utilization management professionals review medical cases to ensure that treatments and procedures are medically necessary and align with established guidelines. Their goal is to optimize healthcare outcomes while controlling costs and preventing unnecessary services, ensuring members receive the right care at the right time.

What are the key skills and qualifications needed to thrive as a Kaiser Utilization Management professional?

To thrive in Kaiser Utilization Management, you need a solid background in clinical healthcare (often as an RN or other licensed clinician), understanding of medical necessity criteria, and experience with healthcare regulations. Familiarity with utilization review software, electronic health records (EHRs), and knowledge of guidelines such as Milliman or InterQual are typically required. Excellent communication, critical thinking, and organizational skills set standout professionals apart in this role. These competencies ensure effective resource management, regulatory compliance, and quality patient care within the healthcare system.

How does a Kaiser Utilization Management professional typically collaborate with healthcare providers to ensure appropriate patient care?

Kaiser Utilization Management professionals work closely with physicians, nurses, and other healthcare team members to review patient cases and ensure that treatments and services are medically necessary and align with organizational guidelines. This collaboration often involves case discussions, care planning meetings, and providing recommendations for alternative care options when appropriate. Open communication and a collaborative approach help ensure patients receive high-quality care while also managing resources efficiently. Professionals in this role regularly interact with both clinical and administrative staff to resolve issues and support optimal patient outcomes.

What is the difference between Kaiser Utilization Management vs Kaiser Case Manager?

AspectKaiser Utilization ManagementKaiser Case Manager
Primary RoleReview and authorize healthcare services based on medical necessityCoordinate and manage patient care plans and services
CertificationsTypically requires medical or nursing credentials, possibly certifications in utilization reviewOften requires nursing or social work credentials, with case management certifications
Work EnvironmentUtilization review departments within health plans or hospitalsDirect patient interaction, care coordination teams, healthcare facilities
Industry UsageCommonly employed by health insurance providers like KaiserEmployed in healthcare settings, insurance companies, or integrated health systems

While both roles are integral to healthcare management at Kaiser, Utilization Management focuses on reviewing services for appropriateness, whereas Case Managers actively coordinate patient care and services. Understanding these differences helps clarify career paths and job expectations within Kaiser’s healthcare system.

What are popular job titles related to Kaiser Utilization Management jobs in Hawaii?

For Kaiser Utilization Management jobs in Hawaii, the most frequently searched job titles are:

What job categories do people searching Kaiser Utilization Management jobs in Hawaii look for?

The top searched job categories for Kaiser Utilization Management jobs in Hawaii are:

Kaiser Utilization Management jobs near you
Infographic showing various Kaiser Utilization Management job openings in Hawaii as of August 2026, with employment types broken down into 1% As Needed, 79% Full Time, 18% Part Time, and 2% Contract. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution.

Case Manager & Care Coordinator - Maui Lani

Kaiser Permanente

Wailuku, HI • On-site

Other

Posted 18 days ago

Kaiser Permanente rating

8.2

Company rating: 8.2 out of 10

Based on 927 frontline employees who took The Breakroom Quiz

54th of 898 rated healthcare providers

Job description

Job Summary:

Provides case management and outreach services to selected patients. Provides discharge planning services and assists with follow-up for Health Plan members hospitalized at community hospitals. Incorporates Risk Management, Quality Management and Utilization Management concepts into daily hospital and clinic activities.

Essential Responsibilities:


  • Implements Continuing Care programs and initiatives with Continuing Care providers and PCP Team. Assists with integrating programs and initiatives into daily practice. Makes clinic/location-specific adaptations as necessary to insure successful implementation of model. Monitors and evaluates outcomes.

  • Provides case management services to targeted patients/families by interviewing and evaluating their needs. Develops work plans to assist patients/families in meeting identified needs. Coordinates resources and services to assure continuity and quality of care. Maintains working knowledge of community resources. Interprets Kaiser Permanente benefits/services to patients, families, and members of community.

  • Monitors high-risk members and assists them with access to care. Integrates patients into existing programs/services. Evaluates outcomes and makes recommendations for change.

  • Assists patients/families with identified problems/concerns.

  • Meets with Continuing Care providers and PCP Team to monitor targeted patients. Assists Team by coordinating community care. Explores options to assure that quality, cost-efficient care is provided.

  • Makes daily hospital rounds for early identification of UM and discharge planning activities. Assists physician/patient/family in planning discharge. to facilitate smooth transfer to home or alternate facility.

  • Reports any Risk/Quality/Utilization Management issues to Neighbor Island Management Team.

  • Acts as contact person for MOA/Oahu discharges. Assists patients with smooth transfer to home.

  • Participates in community hospital interdisciplinary team meetings.

  • Maintains confidentiality of all patient information.

  • May perform patient care to the extent necessary to maintain clinical expertise, competency and licensing necessary to fulfill job responsibilities and to direct the provision of care on the unit.

  • Develops and maintains collegial and consultative working relationship with Government Programs office staff to assure that all regulatory requirements are met and necessary changes are implemented.

  • Attends community seminars and workshops specific to professional needs. Participates in approved educational programs.

  • Assists in developing, implementing, maintaining, evaluating, and enhancing Total Quality Management activities within organization. Makes suggestions for change/improvement as indicated.

  • Incorporates the KP Nursing Vision, Model and Values through out their Nursing Practice.

Basic Qualifications:
Experience


  • Minimum one (1) year of working with low income/high risk patients, preferably in healthcare setting, including experience or successful completion of training program (pre-hire, post-hire, or on-the-job) in area of specialty, if applicable.

Education

  • Bachelors degree in nursing OR four (4) years of experience in a directly related field.
License, Certification, Registration
  • Registered Nurse License (Hawaii) required at hire
  • Basic Life Support from American Heart Association
Additional Requirements:

  • Case management/community outreach experience.
  • Demonstrated knowledge of and skill in oral communication, written communication, interpersonal relations, customer service, change management, multi-task and problem solving.
  • Demonstrated knowledge of and skill in word processing, spreadsheet and database PC applications.
Preferred Qualifications:

  • Program development and operations level implementation.
  • Geriatric experience in outpatient clinic setting.
  • Supervisory/lead experience.

What Kaiser Permanente employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply