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Licensed Nurses & Physician Assistants

The Front Line of Patient Care

Our nurse professionals embody what it means to provide the best patient interactions possible. They also advance the art and science of nursing in a patient-centered, healing environment.

Supervisor Clinical Review

Location: Spokane, WA Additional Locations:
Job Number: 731381 Date posted: 09/11/2018
Description:
Directs the daily operations of Clinical Review nurses, Case Management nurses, and Code Review nursing staff. Ensures appropriate staffing levels to accomplish established regulatory parameters, customer service, quality and productivity goals. Ensures that authorization requests sent to Prior Authorization and identified post service claims are reviewed according to appropriate regulatory, coverage and clinical criteria guidelines. Ensures reviews are done in accordance with state, federal, NCQA and CMS guidelines for timeliness and documentation. Manages staff performance by using performance management tools and providing effective coaching/mentoring. Manages department workloads using daily management systems. Provides appropriate tools and training to staff, and provides timely feedback and documentation through staff meetings and one-on-one meetings. Takes appropriate disciplinary action including counseling, performance improvement plans, etc. In consultation with and under the direction of the Pre-Service Manager, hires and terminates staff as necessary.

Essential Responsibilities:

  • Monitors and acts on daily operations of the Clinical Review, Case Management, and Code Review nursing staff using daily management systems.

  • Manages and monitors daily work product of the Clinical Review, Case Management and Code Review nursing staff.

  • Continuously mentors and coaches staff. Help identify and define tools to perform job duties.

  • Monitors and manages staff performance; counsels, hires, and terminates as necessary.

  • Monitors and adjusts staffing between Clinical Review and Case Management and cross-functionally with other departments within Pre-Service department based on the need to comply with regulatory standards.

  • Basic Qualifications:

    Experience

  • Minimum two (2) years of prior leadership experience in a clinic or utilization management setting.

  • Education

  • Bachelor's degree in nursing.

  • License, Certification, Registration

  • Current WA state RN license by date of hire/transfer.


  • Additional Requirements:

  • Effective communication skills.

  • Computer skills.

  • Knowledge of utilization management; Knowledge of medical benefits adjudication; Use of Milliman clinical criteria; Some knowledge of appropriate coding requirements.

  • Some knowledge of state, federal, NCQA, and CMS regulatory requirements related to pre-authorization.

  • Working knowledge of authorization processing procedures and post service claims processing procedures.


  • Preferred Qualifications:

  • Thorough knowledge of utilization management and medical benefits adjudication; Direct experience using Milliman clinical criteria.

  • Direct knowledge of appropriate coding and billing requirements.

  • Thorough knowledge and experience using state, federal, NCQA, and CMS regulatory requirements.
  • Primary Location: Washington,Spokane,Admin. Center North Spokane 5615 W Sunset Hwy. Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: 8:00 AM Working Hours End: 5:00 PM Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: Salaried, Non-Union, Exempt Job Level: Team Leader/Supervisor Job Category: Nursing Licensed Department: Review Services Travel: No

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    Through professional practice and leadership, nurses at Kaiser Permanente continually advance the art and science of nursing. But we recognize that what we do is more than clinical practice. We believe that every interaction — whether it is with a patient, a colleague, a physician, or anyone else — has the potential to be extraordinary. And we find that approaching our daily routine with this in mind gives each and every action new meaning and allows us to focus on the moment, empowering us to deliver expert care.

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    Physician Assistant Careers

    Physician assistants play a powerful and important role in delivering high-quality, informative care. Working directly with patients, their families, colleagues, and supervising physicians, they are vital in defining the overall care experience.

    Being a physician assistant at Kaiser Permanente is centered on promoting a healing environment — one that maintains a caring, comforting practice while honoring the unity of the whole patient: mind, body, and spirit.

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