Northwest Permanente, P.C., is a self-governed, physician-led, multispecialty group of over 1,500 physicians, surgeons, and clinicians, caring for over 600,000 members in Oregon and Southwest Washington. Kaiser Permanente is one of the nation's preeminent health care systems, a benchmark for comprehensive, integrated, and high-quality care.
The Medical Review Nurse is responsible for serving as a clinical resource to Northwest Permanente (NWP) physicians in the completion of medical certification of serious health conditions that result in the need for employment leave. The RN will complete comprehensive nursing reviews of the patient medical records and provide recommendations to the treating provider based on the condition, treatment plan, and effect the condition has upon the individual patient. The SMARTeam RN will apply scientific evidence, practice experience, and nursing judgement within the scope of the RN license.
Major Responsibilities/Essential Functions
Determines if patient has a serious health condition that qualifies for medical certification under federal and state regulations.
Completes comprehensive nursing assessment of the patient's medical record to determine how the serious medical condition is impacting the patient's overall health and daily activities. Assessment includes collecting and evaluating data and developing a subsequent patient-centered plan of care through the application of scientific evidence, practice experience, and nursing judgment.
Recommends patient-centered plan to treating providers as indicated by the comprehensive nursing assessment.
As needed, seeks input from medical director to assist with complex cases, clinician education, and clarification on regulatory requirements.
Collaborate with customer departments (i.e. ROI in the NW) in addressing inter-departmental workflows focusing on continuous process improvement.
Responds to feedback regarding customer service concerns and communicate to appropriate personnel; following through to assure that identified customer and patient issues are satisfactorily addressed.
Develop and maintain working knowledge of federal, state and local disability related regulations and legislation, related to medical certifications provided by treating providers.
Participates in department and regional meetings as requested. Additional duties as assigned to assist in department.
Bachelor's degree in nursing.
Master's degree in nursing.
Specialty certification highly desirable.
Minimum Work Experience and Qualifications
Five (5) years' work experience as an RN.
Preferred Work Experience and Qualifications
Ten (10) years' work experience as a RN
Three (3) years as a RN in Kaiser Permanente in outpatient setting.
Previous experience with occupational or rehabilitation medicine or similar experience.
Previous experience in utilization management and/or case management.
Previous experience in quality improvement and use of CQI tools and techniques.
Experience performing nursing quality reviews for the purpose of providing recommendations to the treating provider(s).
Mastery in Epic.
Working knowledge of Medical Certification for employment leave guidelines.
Required Licensure, Certification, Registration or Designation
Current RN license in Oregon and Requires Oregon or Washington license at time of hire. Licenses in both states are required within 6 months of hire/transfer with application required within 2 weeks of hire/transfer.
Additional licensing in States where shared services are indicated; to be determined based upon the needs of the department.
At Northwest Permanente, P.C., we are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants without regard to race, color, religion, sex, pregnancy (including childbirth, lactation and related medical conditions), national origin, age, physical and mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military and veteran status, and any other characteristic protected by applicable law. Northwest Permanente, P.C. believes that diversity, inclusion, and equity among our employees is critical to our success and we seek to recruit, develop and retain the most talented people from a diverse candidate pool.
Physician Opportunities in Oregon & Southwest Washington. For more information please visit https://nwpermanente.com/jobs/About Us - Northwest Permanente is the Northwest’s largest physician-led, self-governed multispecialty group. We have opportunities available across the region in Portland, Salem, Oregon, and Longview, Washington. Northwest Permanente physicians practice medicine with a purpose that provides unparalleled opportunities for a meaningful and rewarding career in medicine.