Provides assessment and monitoring of resource utilization, coordinates outside referrals, provider practice patterns, quality of care, and coordination of our members continuing care needs. Maintain and support a culture of compliance, ethics and integrity. Responsible for ensuring ongoing compliance for the department. Maintains knowledge of policies and procedures and performs in accordance with applicable regulatory requirements, external laws and accreditation standards as they relate to the department.

• This position, knows and complies with all Kaiser Permanente quality, safety, and emergency policies and procedures. Demonstrates quality and effectiveness in work habits and clinical practice in every interaction with patients, colleagues, providers, and leadership. Ensures patient safety in the preparation and provisioning of care related to but not limited to medications, procedures, infection prevention, fall prevention, including consistent use of two patient identifiers and procedural time outs. Reports safety hazards, accidents and incidents, and unsafe working conditions promptly.
• Determines and manages appropriate levels of care and services; using clinical knowledge, established guidelines and physician consultation.
• Implements changes in contract benefits, state and federal regulations, and established review criteria guidelines.
• Synthesizes and analyzes a large volume of data related to the member, benefits, eligibility, facilities, contracts, and clinical status to identify issues and facilitate problem solving that results in continuity of care, quality of care and optimal resource management for the patient.
• Coordinates care with various internal and external customers to facilitate high quality, timely, and cost effective care and service.
• Consults and educates other staff, physicians, departments and members regarding resource management options that provide high quality while efficiently using available resources.