RentonRecruiter Since 2001
the smart solution for Renton jobs

Clinical Review Unit Physician

Company: National Medical Association
Location: Renton
Posted on: November 19, 2022

Job Description:

About Us Washington Permanente Medical Group (WPMG) is a clinician-led, self-governed and independent multi-specialty group practice, providing care to the more than 700,000 Kaiser Permanente patients in Washington state. We work unencumbered by traditional health care obstacles and without silos; prioritizing people over profits, collaboration over ego, and driven by a singular goal: our patients' health. At WPMG, we take care of the whole person, with a team to address the fundamental, social, and emotional needs that contribute to total health. We are clinicians motivated by the desire to make a purposeful difference in the communities we serve, and in how health care is delivered. Summary Kaiser Permanente-Washington Permanente Medical Group is seeking Clinical Review Unit Physicians to join our team. We are recruiting three physicians and the FTE will be divided accordingly. Clinical reviewer unit physicians ensure that requests for coverage are adjudicated using professionally recognized standards and criteria. Requests are reviewed for clinical indications, appropriateness, and compliance with contract language. This is achieved through well documented case review, the consistent application of decision tools, criteria and data collection, and feedback to regional medical directors, program chiefs, individual physicians and care management related to clinical review outcome trends. PRINCIPAL DUTIES & RESPONSIBILITIES Responsibility Description Professional Competence Conducts clinical reviews on potential coverage denials based on the application of clinical review criteria and is able to meet the regulatory standards for review timelines. Documents the review process and decisions for determination of coverage thoroughly, and submits the outcome, including a summary of rationale that can be used in the letter sent to the patient and providers to the review staff within predefined timelines. Works with the external delivery system to ensure their understanding of the referral and clinical review process and its relationship to the clinical review criteria.

  • Manage standard and expedited patient appeals within regulatory timelines, seeking specialty expertise when indicated.
  • Participates in Administrative Law Judge hearings for beneficiaries as needed.
  • Familiarity with hospital management, case management, utilization review, clinical pathways, and quality management.
  • Must employ an understanding of health maintenance organizations, contract language, managed care environments and modern healthcare management in an integrated group practice setting, including through knowledge of industry trends. Teamwork and Collaboration
    • Assists in the development of clinical review criteria and programs.
    • Able to work well with other health professionals (RN's, case managers) to effectively facilitate appropriate level of care for KPWA patients in a variety of care settings.
    • Comanage concurrent review with the Centralized Inpatient Administration team in an effort to help achieve organizational targets.
    • Works with the Clinical Guidelines staff, Medical Technology Committee, and Pharmacy and Therapeutics Committee in reviewing requests for new services to determine whether they are medically necessary, effective or experimental or investigation.
    • Assist in weekend call via telephone and computer. Service Excellence
      • Provides education, consultation and feedback to other medical directors, review staff and care management related to clinical review criteria and outcomes
      • Provides physician review component to determine appropriate coverage, level of care, length of stay for hospital, skilled nursing facility, inpatient rehabilitation and long-term acute care facilities. Work with KPWA care managers managing review of hospital admissions, transfers, discharges. Understanding of appropriate levels of care including inpatient, LTAC, skilled nursing care, and custodial care. JOB SPECIFICATIONS EDUCATION REQUIRED DESCRIPTION PREFERRED Minimum: Medical Degree Completion of an accredited residency in internal or family medicine Documentation of additional training in health plan review, utilization management, and quality programs. Certificate of Medical Management, MBA, MHA, MPH EXPERIENCE REQUIRED DESCRIPTION PREFERRED Minimum: 3 or more years of clinical practice experience, including outpatient primary care, and one year of experience in utilization/quality management, including a minimum one year of experience as a hospitalist or extensive hospital rounding experience. Four to six years' experience in clinical practice with two to four years of experience as a hospitalist or extensive hospital rounding experience. One to two years of experience as a nursing home attending with an additional three years in utilization/quality management, and some related to health plan management. Experience leading teams in analysis, planning, implementation and monitoring the implementation of new programs and processes, clinical pathways and quality management Knowledge of regulatory and certification requirements, which impact utilization management, referral management and care coordination design. CERTIFICATIONS REQUIRED DESCRIPTION PREFERRED Minimum: MD, DO Washington State physician and surgeon license. A current license to practice without restriction Credentialed by KPWA Washington Permanente Medical Group Health Shareholder Board Certified by ABMS or member of ACPE None KNOWLEDGE & SKILLS Knowledge: Areas of specialty or expertise (e.g., intermediate knowledge of research methodology and data collection modalities) Skills: Abilities needed to execute job duties (e.g., advanced writing and documentation skills) KNOWLEDGE/SKILL DESCRIPTION REQUIRED/PREFERRED Champions Innovation and Change
        • Ability to identify opportunities and generate ideas for change and innovation.
        • Demonstrated ability to implement change initiatives and create sustainable improvement
        • Superior critical thinking and analysis skills required
        • Foster a continuous improvement culture Required Collaborates
          • Builds productive rapport with key stakeholders
          • Exceptional customer service and networking skills. Ability to work with high level leaders.
          • Creates opportunities for teams to improve effectiveness and share information.
          • Fosters an inclusive work environment. Required Communicates Effectively
            • Demonstrated communication, strong negotiation, and mediation skills.
            • Clearly and concisely communicates verbally and in writing.
            • Encourages, respectfully listens to and acknowledges diverse points of view.
            • Develops shared knowledge to understand what type of and how much information to share for joint success.
            • Clearly communicates roles, goals, and expectations to direct reports. Required Focuses on the Customer
              • Recognizes and resolves problems impacting customers in a timely and professional manner.
              • Sets and adjusts priorities to meet customers' needs.
              • Anticipates customer problems, proactively addresses issues.
              • Models the KP experience standards with staff and customers. Required Develops Self and Others
                • Takes responsibility to build skills and capabilities to enhance performance.
                • Learns from mistakes.
                • Gives direct, constructive feedback to improve performance and grow capability.
                • Effectively delegates, sharing responsibility with others, with sufficient structure, support and monitoring of progress. Required Drives for Results
                  • Thinks of ways to improve results and achieves excellence.
                  • Makes timely, effective day-to-day operational decisions.
                  • Clearly articulates desired results and connection to intended impact and purpose.
                  • Delegates decisions to lowest level possible and empowers others to perform. Required Takes Accountability
                    • Consistently meets commitments to customers, colleagues, and manager.
                    • Takes personal responsibility for own behaviors, results, and decisions.
                    • Engages fully in work, takes immediate and independent action when needed.
                    • Exhibits self-awareness and cultural agility. Required As a condition of employment, all clinicians and employees are required to verify COVID-19 vaccination status. As part of the pre-boarding process and before starting work, you will be required to verify your vaccination status, and will be provided an opportunity to apply for an accommodation based on a religious or medical reason, if needed. Benefits Benefits include: Full malpractice indemnification (including tail coverage), medical/dental/vision benefits, 401(k) & employer-paid retirement contributions, paid vacation, CME, long-term disability, long-term care benefits, and the ability to become a shareholder in our group practice. Community Renton, with a population of 101,300, is located on the south shore of Lake Washington with spectacular views of the lake, the Olympics, the Cascades, and Mount Rainier. The Cedar River runs through the heart of downtown and offers an abundance of natural beauty and a run of federally endangered chinook salmon. The City is centrally located for access to the regions' transportation network, accessible by four state and three interstate highways, only minutes away from Seattle, Bellevue, Tacoma and Sea-Tac Airport. Renton's strong economic base, diverse marketplace and favorable business climate have attracted the attention of nationally recognized companies that are looking to provide employees and their families with an outstanding quality of life. We are dedicated to building lifetime relationships with peers and patients in Washington State's richly diverse communities. Many know the Pacific Northwest as an attractive tourist destination with beautiful scenery, friendly people, and a host of cultural and recreational opportunities. These elements, and others, make Washington an excellent place to live. Equity, Inclusion and Diversity In our local communities and across the nation, Kaiser Permanente sets the standard for respectful care. With multicultural staff, equity, inclusion and diversity councils, medical interpretation resources, outreach efforts, educational programs and more, Kaiser Permanente puts people first in our medical centers and beyond. As part of Kaiser Permanente, Washington Permanente Medical Group (WPMG) seeks to create equity in our communities, eliminate health disparities, and always put patients--the heart of everything we do--first. Following the guidelines in our National Diversity Agenda, every member of our team strives to:
                      • Provide culturally responsive and appropriate medical care to improve the health and satisfaction of all people in our increasingly diverse membership
                      • Recruit and retain clinicians and staff that enhance our workforce
                      • Grow our membership by providing exceptional service and clinical care to all communities in our region Creating a diverse workforce, an inclusive environment, and equitable opportunity for employment, growth, and advancement are deeply linked to our mission, our business, and our economic future. WPMG continues to add programs that build and maintain a workplace where we engage with our members, communities, and each other--with dignity, respect, and cultural understanding. Equal Employment Opportunity As part of our commitment to our employees and the members and patients we serve, we integrate diversity into all aspects of our operations. Maintaining a workforce with industry-leading levels of diversity through deliberate planning, development, and outreach is critical to fulfilling our mission, sustaining our business objectives, and providing the best level of care to our members and patients. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.

Keywords: National Medical Association, Renton , Clinical Review Unit Physician, Healthcare , Renton, Washington

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category

Log In or Create An Account

Get the latest Washington jobs by following @recnetWA on Twitter!

Renton RSS job feeds