Job Description
Job Summary:
To provide a centrally located and operated initiative for Kaiser Permanente (KP) Southern and Northern California Regions designed to help control emergency claims costs and maintain or improve quality of emergency care received by Health Plan members at non -Kaiser Permanente facilities nationwide. Will review for appropriateness situations, where a Health Plan member is receiving care in an emergency medical situations from community providers (in area and out of area). Will be using emergency medicine/critical care clinical experience and general guidelines, to determine whether to conditionally approve or deny care by community providers or whether to negotiate for lower level of care for the member or whether to refer to the SCPMG/TPMG MD on duty for review or whether to arrange transfer for medically stable members to a Kaiser Permanente Facility or Kaiser Permanente Contract Facilities.
Essential Responsibilities:
+ Prospective u...
To provide a centrally located and operated initiative for Kaiser Permanente (KP) Southern and Northern California Regions designed to help control emergency claims costs and maintain or improve quality of emergency care received by Health Plan members at non -Kaiser Permanente facilities nationwide. Will review for appropriateness situations, where a Health Plan member is receiving care in an emergency medical situations from community providers (in area and out of area). Will be using emergency medicine/critical care clinical experience and general guidelines, to determine whether to conditionally approve or deny care by community providers or whether to negotiate for lower level of care for the member or whether to refer to the SCPMG/TPMG MD on duty for review or whether to arrange transfer for medically stable members to a Kaiser Permanente Facility or Kaiser Permanente Contract Facilities.
Essential Responsibilities:
+ Prospective u...