RN, Specialty Care Review

Learn more about applying for RN, Specialty Care Review at Kaiser Permanente RN, Specialty Care Review at Kaiser Permanente Skip to main content Menu Close Who We Are Mission & History Our Difference Locations Innovation Stories & Resources Life & Culture Accessibility Support Benefits Career Growth Inclusion and Belonging Military Our Community Career Areas Clinical Careers All Clinical Careers Care at Home Mental Health Nursing Careers Nurse Management Careers Pharmacy Careers Rehab Services Early Careers Early Careers Nurse Residency Internships Business Careers All Business Careers Sales & Marketing IT Careers All IT Careers Digital Careers Exec & Leaders Physicians & Dentists Contingent Careers Our Hiring Process Accommodations FAQs Hiring Process Overview Pre-Hire Assessments Searching Jobs & Submitting Interest Talent Network Job Search Job Search Search by Keyword Search by Location Radius Radius 5 miles 15 miles 25 miles 35 miles 50 miles Search Jobs My Profile Saved Jobs (0) Employee Job Search Your skills turn a treatment into her cure. Enable extraordinary moments. RN, Specialty Care Review Primary Location Atlanta, Georgia Employee Status: Regular Worker Location: Onsite Schedule Full-time Scheduled Weekly Hours: 40 Shift Day Salary $42.98 - $54.94 / hour Job Number 1411536 Date posted 10/09/2026 Submit Interest Jump To: Overview Success Profile Benefits Our Culture What Our People Say Job Requirements More From Kaiser Permanente Our Events At Kaiser Permanente our nurses are leaders, clinicians, researchers, innovators, and scientists who are contributing toward being an industry-leading voice for advancing evidence-based care. Whether supporting the patient directly in our hospitals or clinics, providing care at home, serving our patients through innovative virtual technology, or managing care delivery teams, Kaiser Permanente nurses utilize scientific evidence and our integrated care model to optimize the total health of our members and the communities we serve. We invite nurses who are passionate about nursing excellence, high-quality compassionate care delivery, professionalism, integrity, teamwork and patient and family centeredness to join our teams so that we can continue to sustain and build upon our culture of excellence. Job Schedule: Full-time Scheduled Weekly Hours: Shift: Day Success Profile We’re looking for Nurse Leaders who possess the following traits. Collaborative Compassionate Flexible Leadership Socially Conscientious Trustworthy Benefits We offer several benefits to our nurses. Medical, Vision & Dental Retirement Plans Educational Opportunities & Tuition Reimbursement Supportive Teams & Resources Career Growth & Development Our Culture At Kaiser Permanente, we cultivate an environment of compassion, integrity, trust, and open communication that helps our teams do their best work. We believe that lifelong learning will expand our knowledge so we can better serve our patients. Our practice is rooted in research and evidence-based care. Our nurses reflect the rich diversity of our members and communities and provide culturally responsive and competent care that promotes understanding of our members needs and preferences. At Kaiser Permanente, nurses are highly skilled professionals who exemplify leadership, critical thinking, and collaborative problem solving and deliver the right care, at the right time, in the right setting. Hear From Our People Using the search tools below, input your military job title or code and location to see how your skills translate to a career with Kaiser Permanente. --> Caitlin Inpatient Lactation Consultant As an RN/IBCLC in Maternal Child, I’m meeting families at a pivotal time — I’m there to help launch a new family into the world. Everything I do has the potential to impact a family’s health for generations to come. Kimberly Quality Coordinator RN In Hawaii, your community is your family — or ‘ohana.’ I am able to provide extraordinary patient-centered care to my ohana. David Appointment and Advice RN The location is fantastic. Kaiser Permanente is all over the country. You can pick almost any environment you want — from ocean to mountain to city. You’ll still be able to contribute to our mission of providing high quality health care at a local facility. Shawn BSN, RN I chose Kaiser Permanente because their staff and providers really show that they care about you. Also, throughout my 12 years of working here I’m always learning something new, and I’ve had many opportunities for growth and development. Kristen Relief Charge Nurse Working as a nurse at Kaiser Permanente has allowed me the perfect flexible schedule so that I can volunteer as Girl Scout Leader and room parent for both my children. My kids know that I am a hardworking mother who can provide, as well as a mom who can be present and be there for them – and that means everything to me. Jazmin RN, Advice Nurse Working for Kaiser Permanente has allowed me to take control of my future and make my goals a possibility . I feel that Kaiser Permanente allows me to keep climbing and moving. Having that ability truly makes me feel empowered. RN, Specialty Care Review Primary Location Atlanta, Georgia Employee Status: Regular Schedule Full-time Scheduled Weekly Hours: 40 Shift Day Salary $42.98 - $54.94 / hour Job Number 1411536 Date Posted 10/09/2026 Worker Location: Onsite Submit Interest Save Job Description: SIGN ON BONUS OF $10,000 AVAILABLE TO ELIGIBLE EXTERNAL HIRES! Job Summary: Responsible for carrying out medical necessity reviews on all designated referrals for Home Care, DME Specialty Care services. The activities will include telephonic review for medical necessity of the designated services using established criteria and guidelines for coordination of services. Eligibility and benefit reviews will be performed as necessary. Identification of patients for case management, quality improvement reviews, and communication with inpatient care coordinators, case managers, providers, Customer Service, Claims, Contracts and Benefits - Appeals, Risk Management are responsibilities of the position. Essential Responsibilities: Responsible for the day to day review activities as outlined above. Utilizes established criteria to perform medical necessity review for all members requiring home health and DME services. All referral reviews will be performed within the required timeframe and with adherence to the decision notification process. Refers all cases that do not meet established criteria to the appropriate review physician. Performs benefit and eligibility reviews on referrals. Provides investigation and preparation of cases requiring review of the Chief of QRM according to the established guidelines. Understands the Complex Case Management Program and referral process; Refers patients to the Complex Case Managers according to procedure. Provides correspondence in accordance to policy and procedure for members with respect to service requests. Interacts with vendors to ensure that resources are being utilized appropriately while maintaining quality outcomes. Establishes and maintains contact with case manager regarding requests and review status as appropriate. Refers the patient to the social workers as appropriate. Performs quality of care and service reviews using identified quality indicators. Reviews the utilization reports with the Supervisor to assure appropriateness of reviews and makes adjustments based on findings. 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, health care teams, intake coordinators, complex case managers, social workers, inpatient care coordinators, referral coordinators, Member Services, Claims, Contracts and Benefits-Appeals, Risk Management and Kaiser Permanente medical offices to facilitate the review process. Builds effective working relationships with other department. Under the guidance of the supervisor, participates in the maintenance of all QRM policies and procedures related to the Transitional Care Review Program. Participates in call rotation to support after hours and weekend requests for quality resource management services.Refers cases identified as risk management, peer review or quality issues to QAIR and Risk Management. Document Review Activities according to documentation guidelines. Issue letters of non - coverage to members not meeting established medical necessity criteria. 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 the 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 licenser 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 is able to identify location of copy of Principles of Responsibility. Develops and maintains an awareness of how to report compliance issues and concerns. Identifies issues of wrong doing and promptly investigates and reports to immediate supervisor or Director of Regional Compliance. Assures an atmosphere and culture for staff to report issues of wrong doing. Other duties as assigned. Basic Qualifications: Experience Minimum three (3) years of clinical nursing OR completed Kaiser Permanente Nurse Residency Program in KP Georgia. Education B.S. in Nursing or four (4) years of directly related experience. High school diploma or GED required. License, Certification, Registration Registered Professional Nurse License (Georgia) Additional Requirements: Working knowledge of all relevant federal, state, local and regulatory requirements, including Medicare. Functional knowledge of computers. Experience in ICD9/CPT4 coding. Experience in home health and durable medical equipment coordination. Experience with managed health care delivery systems. Preferred Qualifications: Minimum three (3) years of clinical nursing with preferred experience home health, rehabilitation or skilled nursing care. Minimum two (2) years of experience in utilization or case management, discharge planning and quality improvement in a managed care or health care setting preferred. Preferred experience with managed care or health care delivery systems. CCM preferred. B.S. in Nursing. Primary Location: Georgia,Atlanta,Regional Office - 9 Piedmont Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: 08:30 AM Working Hours End: 05:00 PM Job Schedule: Full-time Job Type: Standard Worker Location: Onsite Employee Status: Regular Employee Group/Union Affiliation: GUP|UFCW|Local 1996 Job Level: Entry Level Department: Regional Office - 9 Piedmont - Assoc Rgnl Med Facility - 2808 Pay Range: $42.98 - $54.94 / hour Kaiser Permanente strives to offer a market competitive total rewards package and is committed to pay equity and transparency. The posted pay range is based on possible base salaries for the role and does not reflect the full value of our total rewards package. Actual base pay determined at offer will be based on labor market data, internal alignment, and a candidate's years of relevant work experience, education, certifications, skills, and geographic location. Travel: No On-site: Work location is on-site (KP designated office, medical office building or hospital). Worker location must align with Kaiser Permanente's Authorized States policy. Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status. Submit Interest Save Job Expected Employee Conduct > Share This Job Facebook X LinkedIn Email Navigating the Hiring Process We're here to support you! Having trouble with your account or have questions on the hiring process? Please visit the FAQ page on our website for assistance. Need help with your computer and browser settings? Please visit the Technical Information page for assistance or reach out to the web manager at kp-hires@kp.org . Do you need a reasonable accommodation due to a disability? Reasonable accommodations may be available to facilitate access to, or provide modifications to the following: Online Submissions Pre-Hire Assessments Interview Process If you have a disability-related need for accommodation, please submit your accommodation request and someone will contact you. Other Helpful Links Join Our Talent Network Explore This Location View Stories and Resources Industry Leader Ranked among the nation's best Every hospital that's part of the Kaiser Permanente system earned “high performing” recognition in the latest U.S. News and World Report's annual rankings. That means all 39 of our hospitals are among the top 20% in the nation. Awarded for excellence We're proud that so many of our hospitals have earned Magnet status. It shows our real commitment to outcomes, safety, quality, efficiency, and, most importantly, to our nurses. Recognizing nurses during Nurses Month in 2022 We're thanking each one of our 65,000 Kaiser Permanente nurses for everything they've done for us and for the nation. Thank you for choosing to be a nurse and for leading our transformation of care. Explore a career in nursing When you join Kaiser Permanente as a nurse, you'll help us boldly transform care while also building a career that offers more opportunities for you to grow. Experience nursing excellence At Kaiser Permanente our nurses are leaders, clinicians, researchers, innovators, scientists, and more. It takes an extraordinary team to offer extraordinary care. Our Events Want to talk to a member of the Kaiser Permanente team? Meet us at an upcoming hiring event. See All Events Loading Events... Jobs For You Featured Jobs Recently Viewed Jobs Saved Jobs QRM Acute Transitional Case Manager Atlanta, Georgia, Onsite, Full-time, Day Save Job RN, Specialty Care Review Atlanta, Georgia, Onsite, Full-time, Day Save Job Patient Care Coordinator, Utilization Management Atlanta, Georgia, Onsite, Full-time, Day Save Job You have no recently viewed jobs You currently have no saved jobs Join Our Talent Community Join our Talent Network today to receive email notifications about our career opportunities that match your skills. Sign Up Connect With Us Visit us on X Visit us on Glassdoor Visit us on LinkedIn Visit us on YouTube Visit us on Facebook Visit us on Instagram ©2026 Kaiser Permanente Accommodation Info Terms & Conditions Privacy Practices EEO Statement Technical Information Fraud Notice Sitemap Contact Web Manager Manage Cookies