Patient Care Coordinator RN
Marietta, GA · On-site
... and Kaiser Permanente medical offices to facilitate the inpatient utilization management process and to provide continuity of care. * Builds effective working relationships with physicians ...
Patient Care Coordinator RN
Marietta, GA · On-site
... and Kaiser Permanente medical offices to facilitate the inpatient utilization management process and to provide continuity of care. * Builds effective working relationships with physicians ...
... and Kaiser Permanente medical offices to facilitate the inpatient utilization management process and to provide continuity of care. * Builds effective working relationships with physicians ...
... and Kaiser Permanente medical offices to facilitate the inpatient utilization management process and to provide continuity of care. * Builds effective working relationships with physicians ...
Patient Care Coordinator, RN
Atlanta, GA · On-site
... and Kaiser Permanente medical offices to facilitate the inpatient utilization management process and to provide continuity of care. * Builds effective working relationships with physicians ...
Patient Care Coordinator, RN
Atlanta, GA · On-site
... and Kaiser Permanente medical offices to facilitate the inpatient utilization management process and to provide continuity of care. * Builds effective working relationships with physicians ...
Patient Care Coordinator RN
Duluth, GA · On-site
... and Kaiser Permanente medical offices to facilitate the inpatient utilization management process and to provide continuity of care. * Builds effective working relationships with physicians ...
Patient Care Coordinator RN
Duluth, GA · On-site
... and Kaiser Permanente medical offices to facilitate the inpatient utilization management process and to provide continuity of care. * Builds effective working relationships with physicians ...
Patient Care Coordinator RN
Tucker, GA · On-site
... and Kaiser Permanente medical offices to facilitate the inpatient utilization management process and to provide continuity of care. * Builds effective working relationships with physicians ...
Patient Care Coordinator RN
Tucker, GA · On-site
... and Kaiser Permanente medical offices to facilitate the inpatient utilization management process and to provide continuity of care. * Builds effective working relationships with physicians ...
Patient Care Coordinator RN
Tucker, GA · On-site
... and Kaiser Permanente medical offices to facilitate the inpatient utilization management process and to provide continuity of care. * Builds effective working relationships with physicians ...
Patient Care Coordinator RN
Tucker, GA · On-site
... and Kaiser Permanente medical offices to facilitate the inpatient utilization management process and to provide continuity of care. * Builds effective working relationships with physicians ...
... and Kaiser Permanente medical offices to facilitate the inpatient utilization management process and to provide continuity of care. * Builds effective working relationships with physicians ...
... and Kaiser Permanente medical offices to facilitate the inpatient utilization management process and to provide continuity of care. * Builds effective working relationships with physicians ...
Patient Care Coordinator RN
Mableton, GA · On-site
... and Kaiser Permanente medical offices to facilitate the inpatient utilization management process and to provide continuity of care. * Builds effective working relationships with physicians ...
Patient Care Coordinator RN
Mableton, GA · On-site
... and Kaiser Permanente medical offices to facilitate the inpatient utilization management process and to provide continuity of care. * Builds effective working relationships with physicians ...
... and Kaiser Permanente medical offices to facilitate the inpatient utilization management process and to provide continuity of care. * Builds effective working relationships with physicians ...
... and Kaiser Permanente medical offices to facilitate the inpatient utilization management process and to provide continuity of care. * Builds effective working relationships with physicians ...
... and Kaiser Permanente medical offices to facilitate the inpatient utilization management process and to provide continuity of care. * Builds effective working relationships with physicians ...
... and Kaiser Permanente medical offices to facilitate the inpatient utilization management process and to provide continuity of care. * Builds effective working relationships with physicians ...
Patient Care Coordinator RN
Clarkston, GA · On-site
... and Kaiser Permanente medical offices to facilitate the inpatient utilization management process and to provide continuity of care. * Builds effective working relationships with physicians ...
Patient Care Coordinator RN
Clarkston, GA · On-site
... and Kaiser Permanente medical offices to facilitate the inpatient utilization management process and to provide continuity of care. * Builds effective working relationships with physicians ...
Patient Care Coordinator RN
Atlanta, GA · On-site
$44.14 - $56.66/hr
... and Kaiser Permanente medical offices to facilitate the inpatient utilization management process and to provide continuity of care. * Builds effective working relationships with physicians ...
Patient Care Coordinator RN
Atlanta, GA · On-site
$44.14 - $56.66/hr
... and Kaiser Permanente medical offices to facilitate the inpatient utilization management process and to provide continuity of care. * Builds effective working relationships with physicians ...
... and Kaiser Permanente medical offices to facilitate the inpatient utilization management process and to provide continuity of care. * Builds effective working relationships with physicians ...
... and Kaiser Permanente medical offices to facilitate the inpatient utilization management process and to provide continuity of care. * Builds effective working relationships with physicians ...
Patient Care Coordinator RN
Chamblee, GA · On-site
... and Kaiser Permanente medical offices to facilitate the inpatient utilization management process and to provide continuity of care. * Builds effective working relationships with physicians ...
Patient Care Coordinator RN
Chamblee, GA · On-site
... and Kaiser Permanente medical offices to facilitate the inpatient utilization management process and to provide continuity of care. * Builds effective working relationships with physicians ...
Patient Care Coordinator, RN
Morrow, GA · On-site
... and Kaiser Permanente medical offices to facilitate the inpatient utilization management process and to provide continuity of care. * Builds effective working relationships with physicians ...
Patient Care Coordinator, RN
Morrow, GA · On-site
... and Kaiser Permanente medical offices to facilitate the inpatient utilization management process and to provide continuity of care. * Builds effective working relationships with physicians ...
... and Kaiser Permanente medical offices to facilitate the inpatient utilization management process and to provide continuity of care. * Builds effective working relationships with physicians ...
... and Kaiser Permanente medical offices to facilitate the inpatient utilization management process and to provide continuity of care. * Builds effective working relationships with physicians ...
... and Kaiser Permanente medical offices to facilitate the inpatient utilization management process and to provide continuity of care. * Builds effective working relationships with physicians ...
... and Kaiser Permanente medical offices to facilitate the inpatient utilization management process and to provide continuity of care. * Builds effective working relationships with physicians ...
Patient Care Coordinator RN
Roswell, GA · On-site
... and Kaiser Permanente medical offices to facilitate the inpatient utilization management process and to provide continuity of care. * Builds effective working relationships with physicians ...
Patient Care Coordinator RN
Roswell, GA · On-site
... and Kaiser Permanente medical offices to facilitate the inpatient utilization management process and to provide continuity of care. * Builds effective working relationships with physicians ...
... and Kaiser Permanente medical offices to facilitate the inpatient utilization management process and to provide continuity of care. * Builds effective working relationships with physicians ...
... and Kaiser Permanente medical offices to facilitate the inpatient utilization management process and to provide continuity of care. * Builds effective working relationships with physicians ...
Patient Care Coordinator, RN
Fairburn, GA · On-site
... and Kaiser Permanente medical offices to facilitate the inpatient utilization management process and to provide continuity of care. * Builds effective working relationships with physicians ...
Patient Care Coordinator, RN
Fairburn, GA · On-site
... and Kaiser Permanente medical offices to facilitate the inpatient utilization management process and to provide continuity of care. * Builds effective working relationships with physicians ...
Kaiser Utilization Management information
See salary details
$39K - $50.3K
15% of jobs
$50.3K - $61.5K
8% of jobs
$63.2K is the 25th percentile. Wages below this are outliers.
$61.5K - $72.8K
15% of jobs
The median wage is $79.9K / yr.
$72.8K - $84.1K
20% of jobs
$84.1K - $95.4K
11% of jobs
$101K is the 75th percentile. Wages above this are outliers.
$95.4K - $106.6K
13% of jobs
$106.6K - $117.9K
5% of jobs
$117.9K - $129.2K
3% of jobs
$129.2K - $140.5K
4% of jobs
$140.5K - $151.7K
3% of jobs
$151.7K - $163K
3% of jobs
$39K
$89.5K
$163K
How much do kaiser utilization management jobs pay per year?
As of Aug 14, 2026, the average yearly pay for kaiser utilization management in the United States is $89,483.00, according to ZipRecruiter salary data. Most workers in this role earn between $64,500.00 and $104,500.00 per year, depending on experience, location, and employer.
What is the difference between Kaiser Utilization Management vs Kaiser Case Manager?
| Aspect | Kaiser Utilization Management | Kaiser Case Manager |
|---|---|---|
| Primary Role | Review and authorize healthcare services based on medical necessity | Coordinate and manage patient care plans and services |
| Certifications | Typically requires medical or nursing credentials, possibly certifications in utilization review | Often requires nursing or social work credentials, with case management certifications |
| Work Environment | Utilization review departments within health plans or hospitals | Direct patient interaction, care coordination teams, healthcare facilities |
| Industry Usage | Commonly employed by health insurance providers like Kaiser | Employed 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 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.
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 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.
More about Kaiser Utilization Management jobs
What cities are hiring for Kaiser Utilization Management jobs?
Cities with the most Kaiser Utilization Management job openings:
What states have the most Kaiser Utilization Management jobs?
States with the most job openings for Kaiser Utilization Management jobs include:
What job categories do people searching Kaiser Utilization Management jobs look for?
The top searched job categories for Kaiser Utilization Management jobs are:
Full-time
This job post has expired 1 day ago. Applications are no longer accepted.
Job description
Job Summary:
Responsible for optimizing quality and efficiency of care for hospitalized members by conducting daily utilization and quality reviews, discharge planning, and care coordination. Collaborates with physicians and multidisciplinary teams, developing safe discharge plans, and ensuring compliance with all relevant regulations. The role promotes high customer satisfaction and achieves desired utilization and quality outcomes for the population served.
Essential Responsibilities:
- Utilizes established criteria, to perform daily inpatient review activities, including prospective, concurrent, and retrospective utilization review for all members requiring inpatient admission.
- Performs an admission utilization review upon admission.
- Assesses discharge planning needs and documents assessment using designated tools in EMR for all new inpatient admissions within 24 hours and begins the discharge planning process immediately.
- Conducts a concurrent utilization review of all patients daily and as appropriate based on criteria and policy.
- Assess daily all patients for post-hospital care planning and coordinate discharge plans, ensuring appropriate level of care in the most suitable setting.
- Performs daily bedside rounds on patients and/or significant other to update on discharge planning.
- Reviews charts daily to ensure progression of plan of care and to prepare for daily discharge planning needs.
- Escalate barriers to discharge in real time after usual processes cannot affect discharge.
- Leverages written escalation pathways to ensure timely care and timely discharge for patients.
- Establishes and evolves a discharge plan in parallel with the medical plan to ensure patients discharge plan is ready at the same time as medical clearance.
- Perform and documents a social screening assessment for all patients admitted to hospital and places referrals to internal programs and social workers as appropriate.
- Prepares for and attends all scheduled rounds with physician partners and leaders to discuss clinical courses, discharge planning, barriers to care / discharge and quality concerns.
- Communicate regularly with hospitalist partners and other healthcare team members to monitor patient progress and address delays or quality issues.
- Establishes and maintains contact with patients and their families as appropriate, including the provision of education when needed and planning for discharge along the hospital stay.
- Arranges follow up appointments for medical and surgical patients who are discharged home as needed.
- Ensure that the appropriate level of care is being delivered in the most appropriate setting.
- Performs quality of care and service reviews using identified quality indicators.
- Performs readmission reviews and identifies plan of care for discharge to prevent future readmissions.
- Send appropriate referrals for post-acute needs.
- Secure post-acute services for discharging patients in advance of medical clearance.
- Remains knowledgeable of contract benefits and current, relevant state and Federal regulations, criteria, documentation requirements and laws that affect managed care and case/utilization management.
- Maintains effective interaction/communication with members of the medical staff, nursing staff, complex case managers, home care review team, social workers, general reviewers, referral coordinators, and Kaiser Permanente medical offices to facilitate the inpatient utilization management process and to provide continuity of care.
- Builds effective working relationships with physicians, department staff, post-acute staff, vendors, and other departments within the health plan.
- Assists in the development and revision of guidelines, pathways and protocols.
- Coordinate case conferences for complex cases and facilitate transfers to appropriate facilities.
- Documents a daily progress note in EMR with evolving discharge plan
- Refers cases identified as risk or quality issues to the appropriate department for review using the appropriate reporting tool.
- Document Review Activities to include (according to policy): Medical necessity for admission. Medical necessity for continued stay. Estimated length of stay. Diagnoses. Procedures performed. Demographic Data. Discharge Planning. Physicians are involved in care.
- Issue letters of non-coverage to members not meeting inpatient level of care criteria per established criteria and policy and procedure.
- Works cross-functionally with other departments in striving to meet organizational goals and objectives.
- Achieves and maintains an understanding of relevant state and federal regulations, criteria, and documentation requirements and laws that affect managed care, home health and case/utilization management.
- Knowledgeable and compliant with regional personnel policies and procedures.
- Knowledgeable and compliant with QRM departmental and unit specific policies and procedures.
- Participates in annual regional and departmental compliance training.
- Knowledgeable and compliant with Principles of Responsibility.
- Consistently supports compliance and the Principles of Responsibility (Kaiser Permanentes Code of Conduct) by maintaining privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable federal, state and local laws and regulations, accreditation and license requirements (if applicable), and Kaiser Permanentes policies and procedures.
- Responsible for assisting the Medical Office Administration, Customer Services and Provider Relations in investigating concerns and issues.
- Access to protected health information (PHI) will be limited to the minimum necessary required to effectively perform the job.
- Demonstrates understanding of HIPAA privacy regulations by maintaining confidentiality of Protected Health Information (PHI).
- Demonstrates doing the right thing and doing things the right way is an underlying premise in all work-related activities and can identify location of copy of Principles of Responsibility.
- Develops and maintains an awareness of how to report compliance issues and concerns. Escalates compliance issues to immediate or appropriate supervisors.
- Refers to physician advisor when there is disagreement on patient class, level of care, continued stay or discharge.
- Other duties as assigned.
Basic Qualifications:
Experience
- Minimum two (2) years of RN experience in utilization/case management, discharge planning, quality improvement, or patient care delivery in a healthcare setting.
Education
- Bachelors Degree in Nursing or four (4) years of experience in a directly related field.
- High School Diploma or General Education Development (GED) required.
License, Certification, Registration
- Registered Professional Nurse License (Georgia)
Additional Requirements:
- Working knowledge of all relevant federal, state, local and regulatory requirements.
- Functional knowledge of computers and experience with managed health care delivery, including Medicare.
- Advanced communication and interpersonal skills with all levels of internal and external customers.
- Ability to collaborate effectively with multidisciplinary healthcare teams.
- Excellent time management skills; ability to work in a fast-paced environment.
- Experience in a health plan environment is highly desirable.
Preferred Qualifications:
- Minimum three (3) years of clinical nursing experience, preferably in complex or acute care settings preferred.
- Minimum two (2) years of experience in utilization review, case management, and discharge planning preferred.
- Complex Case Management Certification (CCM) preferred.
- Knowledge of funding, resources, services, and outcomes preferred.
- Masters degree in nursing, Health Care, or Case Management preferred.
Notes:
- Monday thru Friday with rotating weekends and holidays