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Clinical Reviewer, Specialized Medical Ability Resource Team, 1.0 FTE
Kaiser Permanente - Washington Permanente Medical Group
| 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 Full Time 1.0 FTE Clinical Reviewer, Specialized Medical Ability Resource Team to join our WPMG HQ team 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 Specialized Medical Ability Resource Program, including Leaves of Absence: FMLA (Family and 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 Specialized 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:
Collaborates with Business Office staff (Patient Access Representatives), teams and leads in addressing disability related form completion issues and requests as needed. Knowledge & Skills (Preferred) 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. Delivery System: Knowledge of delivery system operations, healthcare delivery systems and trends. Business Acumen: Knowledge of business process and rapid cycle improvement and systems thinking. Decision Making Communications: 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. Experience: Required
Preferred
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:
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.
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https://www.wpmgcareers.org/index.html
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