Nurse Manager (RN)Office: Kaiser Permanente Bldg
Northwest Permanente, P.C. is a self-governed, physician led, multi-specialty group of over 1500 physicians, surgeons, and clinicians, caring for over 600,000 members in Oregon and Southwest Washington. Kaiser Permanente is one of the nation's pre-eminent health care systems, a benchmark for comprehensive, integrated and high quality care. The LOA Medical Review-SMAR Team is seeking a Nurse Manager to provide clinical leadership and oversight to uphold excellence and clinical review competency, of staff, in the provision of nursing clinical review in support of front line physicians through implementation of the professional practice model and evidence-based standards. This position will be accountable for coordinating RN clinical review functions including the implementation of regionally consistent practices, processes, and protocols within a clinical review department to achieve excellence in quality of care, customer service, resource utilization, and employee satisfaction. The Nurse Manager will work closely with the Medical Director in fulfilling the job accountabilities.
This role may perform FMLA clinical review and review of other disability related requests for medical appropriateness to the extent necessary to maintain clinical expertise and competency to fulfill job responsibilities and to direct the provision of clinical review processes within the department and in accordance with licensure and regulatory requirements. Under the direction of the Medical Director, the RN Manager serves as a clinical resource to Northwest Permanente (NWP) physicians for disability related form completion requirements and certifications (e.g. FMLA/OFLA/ADAAA, etc); assists the medical director as liaison and subject matter expert in support of regional and inter regional RN clinical review team(s). This role also serves as the patient communication liaison when necessary as it relates to all aspects of the Medical Ability Resource Program, including Leaves of Absence: FMLA (Family Medical Leave Act), OFLA (Oregon Family 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 members 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.
Major Responsibilities / Essential Functions
Supervision of SMAR Team:
- Collaborates with the leadership team and brings the professional nursing clinical perspective to improve the quality of review processes related to the determination of medically appropriate time away from work. Ensures coordinator support staff working to full scope and/or certification. Collaborates with the Senior Director of Nursing to identify opportunities to optimize scope of practice and ensure resource stewardship.
- Ensures staff have the required knowledge and skill to perform assignment; provide on-going clinical review skills development; develop processes for regional an interregional sharing and implementation of best practices and provide onboarding of new RNs regionally and inter regionally.
- Monitors outcome metrics ($$/time loss savings) via review process for medical appropriateness. Collaborates with leadership team as well as with regional and inter regional counterparts to ensure clinical quality through periodic quality review audits; leads peer review process and identifies and implements remediation process when/if needed. Continuously monitors changes in FMLA laws, ADA, and all other rules, regulations and laws related to FMLA, ADA and other disability related programs.
- Assess urgency of requests for clinical review for the purposes of determining appropriate prioritization and needed actions to assure urgent forms completion.
- Collaborates with Medical Director and regional and inter regional RN services to develop recommendations, implementation plans, and evaluative processes for ongoing process improvement related to clinical review.
- Performs continuous surveillance of all relevant State regulations and Federal regulations pertaining to disability related leave including: Leaves of Absence: FMLA (Family Medical Leave Act), OFLA (Oregon Family Leave Act), WFLA (Washington Family Leave Act) WFCA (Washington Family Care Act), and including other States with shared services, (HI); and the Americans with Disabilities Act Amendment Act (ADAAA).
- Supervises and coordinates staff activities necessary to provide excellent member focused medical reviews for clinician approval. Acts as liaison between the Medical Director, and other support departments to ensure effective communication of overall clinical review processes, including regional communications that cascade to frontline staff.
- Selects, coaches, and develops performance management of nursing staff in compliance with requirements of EEO/AA goals and personnel policies of NWP. Ensures that RNs continuously focus on identifying and implementing ways to meet/exceed quality and service targets and implement regional initiatives.
- Supports the development, implementation, and sustainability of standard workflows for FMLA and other disability related forms completion processes. Monitors and controls expenditures, overtime, and staffing levels. Maintains current information and ensures that clinical activities and training incorporate all applicable NWP policies, local, state, and federal laws and regulations and accreditation standards included inter regional licenses as required to support shared services.
- Ensures compliance with related Patient Safety, EH&S regulations, training requirements and regional emergency preparedness expectations. Researches and resolves customer complaints. Supports Medical Director in working collaboratively with physician groups and others in the organization (regionally and inter regionally) as well as with employer groups and other external partners to ensure provision of high quality, patient centered clinical review services.
- When staffing not able to meet demand, works alongside staff performing comprehensive reviews.
- Collaborates with leadership team to ensure adoption through training and implementation of procedures designed to impact quality measures as appropriate, i.e., organizational and department-specific quality and continuous improvement goals.
- Prepares assigned team(s) for all KPHC upgrades and enhancements in partnership with the KPHC team.
- Supports regional and inter regional projects and committees related to process improvement and sharing of best practices.
Minimum Education and Work Experience
- Bachelor’s degree in nursing
- Five (5) years of leadership and managerial experience including working with variety of healthcare team members managing through influence and collaboration
- Five (5) years of supervisory experience to include but not limited to, hiring, disciplinary actions, training, employee development/ assessment, and wage and hour regulations.
- Five (5) years of experience providing direct patient care.
- Demonstrated understanding of clinical and operational processes, staff licensure/certification, clinical competency requirements, and scope of practice concepts.
- Ability to analyze, integrate and use quantitative data informed decisions about quality improvement and collaborating with clinical staff, support staff, and team to achieve expected outcomes.
- Ability to lead in a culturally diverse environment and promote culturally competent care.
- Ability to communicate effectively in written and spoken English.
- Ability to attend to details, prioritize and complete multiple tasks independently in a fast-paced environment and following agreed upon timeline.
Required Licensure, Certification, Registration (LCR)
- Current Oregon and Washington RN license required.
- License in state where assigned required upon hire/transfer, application for license in secondary state required within 2 weeks of hire/transfer and must be obtained within 6 months. Additional licensing in States where shared services are indicated.
- Master's degree in nursing, healthcare, business administration, or related field.
- Specialty certification highly desirable.
Preferred Work Experience and Qualifications
- Seven (7) years health care administration in a variety of settings including ambulatory and hospital care
- Ten (10) years of supervisory experience in a health care setting.
- National certification in related clinical field.
- Hospital and Ambulatory Care experience.
- Ability to apply process improvement and project management principles.
- Ability to performance manage, coach, and develop staff.
- Ability to understand and utilize data to improve performance.
- Ability to lead and implement change management and process improvement activities.
- Ability to establish partnerships with physician group, KP HealthPlan (ROI, Marketing/Sale) and KP inter regional partnerships and peers to create a culture of commitment to patient focused service, excellent support of clinical review practices, innovation, compliance, safety, and integrity.
- Case management/disability management
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.