Description
Job Details
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 a part-time 0.5 FTE Clinical Reviewer to join our Specialized Medical Ability Resource Program - SMART team at our WPMG HQ in Renton, Washington.
Job Summary
The Clinical Reviewer for the Specialized Medical Ability Resource Program is an active member of the Specialized Medical Ability Resource Team (SMARTeam), who provides centralized medical chart reviews services, including but not limited to standardized processes for reviewing medically necessary time away from work and other disability form requests. The SMARTeam Clinical Reviewer serves as a clinical resource to WPMG clinicians for disability related form completion requirements and certifications (e.g. FMLA/ADA, etc.) This position also includes serving as patient communication liaison as needed for complicated cases related to all aspects of the Medical Ability Resource Program, including Leaves of Absence: FMLA (Family Medical Leave Act), WFLA (Washington Family Leave Act), WFCA (Washington Family Care Act), Workers' Compensation, claims under the Americans with Disabilities Act Amendment Act (ADAAA), and employees with non-occupational injuries or illnesses. The key objective is to maintain accurate communication and education of the Medical Ability Resource Program philosophy and regulations.
Principal Duties & Responsibilities
* Independently and proactively complete Medical Certifications through medical chart reviews in Epic providing recommendations for time off work to clinicians.
* Recommend time away from work based on clinical judgment supported by relevant tools, utilization of evidence based guidelines, application of principles of the Medical Ability Resource Program, and input from disability management clinician leads as necessary.
* Assist in providing disability related education and feedback to clinicians with the goal of decreasing the variability in work absence clinical decision making and reducing the administrative burden for clinicians.
* Communicate effectively when working with clinicians to address disability related questions.
* Develop and maintain expertise in federal, state and local disability related regulations and legislation, including, but not limited to FMLA, WFLA, WFCA, ADA, etc., as well as Disability Duration Guidelines, and Milliman Criteria. Collaborates in on-going clinical review skills development and implementation of best practices.
* Monitor and track FMLA Medical Certifications and disability forms utilizing secure databases to support continuous clinical quality improvement, eliminating re-work and improving disability management systems and processes.
* Support WPMG goals and objectives to improve patient care, disability prevention and management.
* Obtain feedback regarding customer service concerns and communicate to appropriate personnel to ensure that identified patient concerns are satisfactorily addressed.
* Collaborates with Program's Medical Director in clinician education and actively contributes to program development:
* Collaborate with others in the interdisciplinary healthcare team to ensure that regulatory and compliance standards are met.
* Participate in quality and inter-rater reliability review activities.
* Assist with ensuring that regulatory and compliance standards are met in applying disability prevention and management principles.
* Contribute to the development and updating of disability related training and education materials.
* Participate in professional committees/task forces as needed/requested.
* Collaborates with Business Office staff (Patient Access Representatives), teams and leads in addressing disability related form completion issues and requests as needed.
* Other duties as assigned.
Knowledge and Skill Required
* Working knowledge of FMLA/WFLA and ADA guidelines
* Ability to work effectively with medical staff
* Demonstrated customer focused service skills
* Ability to navigate medically relevant databases
* Ability to handle highly confidential and other information with discretion.
* Experience completing medical chart reviews.
* Proficiency in the use of electronic medical record systems such as Epic
* Professional written and verbal communication and interpersonal skills
* Competence with medical record review and analysis
* Reliable clinical judgment and appropriate application of clinical knowledge related to assessment of appropriate medical care
* Experience providing direct patient care
* Ability to attend to details, prioritize and complete multiple tasks independently in a fast-paced environment and following agreed upon timeline
* Demonstrate the ability to identify critical issues, exercise independent judgment and function as a team member
* Experienced user in Microsoft Office software
Management
Demonstrated leadership skills with the ability to direct the activities of others on a direct or matrix team basis.
Ability to collaborate and be influential across structures and roles.
Preferred
Delivery Systems
Knowledge of delivery system operations, healthcare delivery systems and trends.
Preferred
Business Acumen
Knowledge of business process and rapid cycle improvement and systems thinking.
Preferred
Decision Making Communication
Ability to challenge established ways and lead change.
Demonstrated effective problem solving and decision-making skills.
Proven negotiation and conflict resolution skills.
Excellent communication skills.
Preferred
Benefits
Benefits include: Medical/dental/vision benefits, 401(k) & employer-paid retirement contributions, paid vacation, long-term disability, long-term care benefits.
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.
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