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Account Manager I
American Red Cross
Statewide, OH
We are seeking an Account Manager for our Ohio Region
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Process Reliability Engineer
Austin Powder Co., Inc.
McArthur, OH
…contractors. The position reports directly to the Sr. Maintenance Manager located in McArthur, Ohio. Responsibilities and Duties * Works with a small team (production, technical,…
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Senior Product Marketing Manager - Specialty surfactants
Univar Solutions USA Inc.
Powell, OH
…that energize and excite you. As a Senior Product Marketing Manager (Supplier Manager) for Univar Solutions Ingredient + Specialties, you will foster continuous sales growth in sales in the…
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Senior Manager - Project Program Management
CVS Health
Remote, United States
…through completion, including regulatory compliance, survey implementation, vendor and contract management, budgeting, data reporting, risk management, process improvement, and stakeholder…
Added 1 min ago
STORE MANAGER CANDIDATE - MASSILLON, OH STORE #31676
Dollar General
Massillon, OH
The Store Manager Candidate supports the Store Manager in the effective implementation of all store processes including employee supervision, staffing, inventory management, stocking and…
Added 1 min ago
Senior Safety, Health, & Environment Specialist
Henkel
Delaware, OH
Monitors, communicates and executes implementation of regulation changes.
Added 1 min ago
EC
HR Manager, IT and Business Performance
Eaton Corporation
Beachwood, OH
- $130,000 to $190,000 USD / year
Eaton’s Corporate Sector division is currently seeking a HR Manager, IT and Business Performance. This position will be based at our Beachwood, Ohio location. Relocation assistance is…
Added 1 min ago
EC
Regional Manager, Manufacturing Excellence
Eaton Corporation
Beachwood, OH
- $130,000 to $190,000 USD / year
Eaton’s Corporate Sector division is currently seeking a Regional Manager, Manufacturing Excellence. This is a U.S.-based remote position offering the flexibility to work remotely while…
Added 1 min ago
Electrical Test Engineer - Power & Control Systems (PTC)
HX5 Sierra LLC
Sandusky, OH
…5 Type of Position Regular Full-Time Level Experienced (Non-Manager) Visa Requirements Citizen only Overview The Test Facilities Operation, Maintenance and Engineering (TFOME) III contract…
Added 1 min ago
STR MGMT/OVERNIGHT ASST STORE LEADER
Kroger Family of Companies
Sandusky, OH
Instruct and train 3rd shift associates in proper ordering, execution of sales plan, implementation of product mix to support consistent sales, profit and tonnage growth
Added 1 min ago
C
Quality Manager-Data Center
CBRE
New Albany, OH
- $117,000 to $120,000 USD / year
We are looking for a Construction Quality Manager (QM) whowill support our project management and leadership teams by providingmanagerial oversight of the site-level quality assurance and…
Added 1 min ago
ConvergeProsperity - Lead Product Forward Deployed Engineer for FSI Signals - Products & Platforms
Deloitte
Kansas City, MO
…to sell products to clients. You will be part of the General Manager's leadership team, responsible for proactively bringing ideas that push the business forward, weighing in on key…
Added 1 min ago
ConvergeProsperity - Lead Product Forward Deployed Engineer for FSI Signals - Products & Platforms
Deloitte
Saint Louis, MO
…to sell products to clients. You will be part of the General Manager's leadership team, responsible for proactively bringing ideas that push the business forward, weighing in on key…
Added 1 min ago
Cloud Engineering and Reliability Manager
Vontier
Akron, OH
The Manager, Cloud Engineering and Reliability provides strategic and operational leadership for DRB’s cloud infrastructure, platform operations, and systems engineering capabilities. This…
Added 1 min ago
Connector Territory Mgr - Toledo, OH , Dayton, OH
PARKER HANNIFIN CORPORATION
Toledo, OH
Added 1 min ago
Warehouse Leader
MAHLE Thermal and Filter Systems Dayton
Dayton, OH
…Supply Chain Logistics and Operation teams and reports to the Manager and Head of Logistics. This position has 6 direct reports and manages the warehouse made up of approximately 110 team…
Added 1 min ago
Street Outreach Program Coordinator
Bellefaire JCB
Cleveland, OH
The Street Outreach Program (SOP) Outreach Coordinator is responsible for implementation and ongoing operations. He/She provides direction, coordination, plus leadership and supervision to…
Added 1 min ago
Senior Services Operations Manager, Managed Services
Ricoh Americas Corporation
Cleveland, OH
The Senior Services Operations Manager, Managed Services functions in a leadership role as operational point of contact to assigned Global/Vertical customers, primarily in North America.
Added 1 min ago
HR GENERALIST
Kroger Family of Companies
Cincinnati, OH
…overall strategic business partnerships. Assist the Total Rewards manager and Human Resources (HR) director of logistics regarding HR projects and administrative functions. Partner with…
Added 1 min ago
Gas Layout Technician
Duke Energy Ohio, Inc
Cincinnati, OH
…assigned Duke Energy facility as required and directed by their manager, on average 3 full workdays per regular workweek. ***** For clarification, 20 semester credits above the entrance…
Added 2 mins ago
Sr Sales Training Manager - East Coast Remote
ThermoFisher Scientific
Cincinnati, OH
The Sr Manager, Sales Training will be a part of the Pharma Services Group Sales Training team in the Commercial Operations Group. This individual will share responsibilities for the…
Added 2 mins ago
Technical Program Manager, Knowledge Systems
Coinbase
Columbus, OH
…internal tools, and AI-assisted support. As Technical Program Manager, you will translate knowledge strategy into technical execution. This is a systems-focused role bridging customer…
Added 2 mins ago
DevOps Engineer III
Deloitte
Cleveland, OH · Columbus, OH · Cincinnati, OH
…Foundry, AI & E/EaaS - DevOps, you will support the design, implementation, and optimization of cloud, automation, and platform engineering solutions across complex environments. This role…
Added 2 mins ago
Traveling Program EHS Director - MSG - Advanced Technology Group
Turner Construction Company
Columbus, OH
…related to EH&S. Review and provide feedback to Operations Manager (OM) on business and subcontract agreements related to EH&S. Lead and provide direction for decision-making for key EH&S…
Added 2 mins ago
STORE MANAGER CANDIDATE - COLUMBUS, OH STORE #8422
Dollar General
Columbus, OH
The Store Manager Candidate supports the Store Manager in the effective implementation of all store processes including employee supervision, staffing, inventory management, stocking and…

Kaiser Permanente

Case Manager, Utilization RN - PRN

Denver, CO, United States

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Job details

Posting language: English
Posted: Nov 5, 2026

Original job description

-May be entitled to translation/bilingual, shift or other wage premiums as governed by the applicable collective bargaining agreement. Please refer to the respective collective bargaining agreement for additional information on such wage premiums: https://www.lmpartnership.org/local-contracts.

Job Summary:

Works collaboratively with an MD to coordinate and screen for the appropriateness of admissions and Continued stays either telephonically or on-site. Makes recommendations to the physicians for bed day management andalternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization, skilled nursing or post-acute benefits. Interacts with the family, patient and other disciplines (including but not limited to MDs, RNs, Social Workers) to coordinate a safe and acceptable discharge plan, as needed. Functions as an indirect caregiver, patient advocate and manages patients in the most cost-effective way without compromising quality.

Essential Responsibilities:

Transfers stable non-members to planned Health care facilities. Responsible for complying with AB 1203, Post Stabilization notification. Complies with other duties as described. Must be able to work collaboratively with peers, multidisciplinary teams and multitask and in a fast pace environment.
Plans, develops, assesses and evaluates care provided to members. Reviews, monitors, valuates and authorizes the medical necessity of inpatient, skilled, or sub-acute admissions demonstrating knowledge and experience in the application of clinical criteria to determine medical necessity for inpatient hospitalization, skilled nursing or post-acute venues of care. Performs all utilization review activities according to Resource Stewardship department policies and procedures.
Participates in clinical review round activities preparing case presentation and documentation. Notifies facilities and others of review decisions timely after applying approved criteria and/or established guidelines, including adverse determinations, as recommended by the Medical Director. Identifies high-risk/high utilizers of services to monitor their intensity and level of services and reports potential high dollar cases appropriately per policies and procedures. Recommends alternative levels of care and ensures compliance with federal, state and local requirements. Assesses high risk patients in need of post-hospital care planning. Develops and coordinates the implementation of a discharge plan to meet patients identified needs in collaboration with discharge planners and care managers, as necessary. Documents all necessary information timely into medical management systems or pursuant to appropriate policies and procedures ensuring complete and accurate data. Participates in the Bed Huddles and/or telephonic concurrent review calls and carries out recommendations congruent with the patients needs.
Coordinates the interdisciplinary approach to providing continuity of care, including Utilization management, Transfer coordination, Discharge planning, and obtaining all authorizations/approvals as needed for outside services for patients/families. Conducts daily clinical reviews for utilization/quality management activities based on guidelines/standards for patients in a variety of settings, including outpatient, emergency room, inpatient and non-KFH facilities. Acts as a liaison between in-patient facility and referral facilities/agencies. Refers patients to community resources to meet post hospital needs through discharge planning and care management. Coordinates transfer of patients to appropriate facilities; maintains and provides required documentation. Adheres to internal and external regulatory and accreditation requirements and compliance guidelines including but not limited to: TJC, DHS, HCFA, CMS, DMHC, NCQA and DOLPerforms other job related responsibilities as may be required from time to time.
Per established protocols, reports any incidence of unusual occurrences related to quality, risk and/or patient safety which are identified during case review or other activities. Participates and or facilitates care planning rounds and patient family conferences as needed. Participates in committees, teams or other work projects/duties as assigned.
The union and the company are currently investigating the qualifications for this position under the bargaining unit. If it is determined that the qualifications are different than as described, appropriate action will be taken.

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Skills

Multitask
Documentation
Regulatory compliance
Care planning
Collaboration
Quality assurance procedures
CMS

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