SMARTeam RN (LOA Medical Review Nurse)
Northwest Permanente (NWP) is a self-governed (physician led), multi-specialty group of over 1,500 physicians, surgeons, and clinicians, caring for over 500,000 members in Oregon and Southwest Washington. NWP is seeking a SMARTeam LOA Medical Review Nurse to join our Medical Ability Resource Department (SMARTeam). The position will report to RN Nurse Manager. The position provides Centralized Nurse Review Team (CRT) services, including but not limited to standardized processes for reviewing medically necessary time away from work and other disability form requests and will serve as a clinical resource to Northwest Permanente (NWP) physicians for disability related form completion requirements and certifications (e.g. FMLA/OFLA/ADA, etc).
Job Post Date: 2017-11-06
Office: Kaiser Permanente Bldg
Kaiser Permanente is committed to helping shape the future of health care. As the largest integrated care delivery organization in the United States, Kaiser Permanente is recognized as one of America’s leading health care providers and nonprofit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve.
Kaiser Permanente Northwest (KPNW)— made up of over 11,000 employees, more than 1,000 physicians and 140 dentists — provides and arranges medical care exclusively for health plan members. In the Portland-Vancouver area, Kaiser Permanente operates 36 medical offices and two hospitals. Today, the Northwest Region serves more than 576,000 medical and 244,000 dental members whose care is largely provided by Northwest Permanente, P.C. (NWP) and Permanente Dental Associates (PDA).
Northwest Permanente (NWP) is a self-governed (physician led), multi-specialty group of over 1,500 physicians, surgeons, and clinicians, caring for over 500,000 members in Oregon and Southwest Washington. NWP is seeking a SMARTeam LOA Medical Review Nurse to join our Medical Ability Resource Department (SMARTeam). The position will report to RN Nurse Manager. The position provides Centralized Nurse Review Team (CRT) services, including but not limited to standardized processes for reviewing medically necessary time away from work and other disability form requests and will serve as a clinical resource to Northwest Permanente (NWP) physicians for disability related form completion requirements and certifications (e.g. FMLA/OFLA/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), 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 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.
Major Responsibilities/Essential Function:
- Independently and proactively complete medical chart reviews in Kaiser Permanente HealthConnect providing recommendations for time off work to physicians and clinicians
- Recommend time away from work based on clinical judgment supported by relevant tools including, application of principles of the Medical Ability Resource Program, utilization of evidence based guidelines and input from disability management physician leads as necessary
- Assist in providing disability related education and feedback to physicians and clinicians with the goal of decreasing the variability in work absence clinical decision making and reducing the administrative burden for physicians/clinicians
- Communicate effectively when working with physicians and clinicians to address disability related questions
- Research complex clinical situations utilizing available guidelines, resources and disability management physician leads
- Monitor and track FMLA certifications and disability forms utilizing secure departmental databases to support continuous clinical quality improvement, eliminating re-work and improving disability management systems and processes
- Support NWP goals and objectives for disability prevention and management
- Obtain 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 expertise in federal, state and local disability related regulations and legislation, including, but not limited to FMLA, OFLA, ADA, etc.
- Assist with physician/clinician education and contribute 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.
- Collaborate with Release of Information department (ROI) in addressing disability related form completion issues and requests as needed
- Other duties as assigned
Minimum Education & Work Experience:
- Bachelor's degree in nursing
- Minimum of 2 years' work experience as an RN
- 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.
- Proficiency in the use of electronic medical record systems such as Health Connect
- 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
- Demonstrate the ability to identify critical issues, exercise independent judgment and function as a team member
- Experienced user in Microsoft Office software
Preferred Education & Work Experience:
- Master’s degree in Nursing
- Minimum five (5) years' work experience as a RN with 3 years as a RN in Kaiser Permanente in either an inpatient or outpatient setting
- Comprehensive knowledge of Northwest Permanente and Kaiser Permanente Health Plan policies and procedures, personnel, goals and objectives, data systems and organizational structures
- Mastery in electronic clinical information systems including KP HealthConnect
- Working knowledge of FMLA/OFLA and ADA guidelines
- Proven ability to establish and maintain effective working relationships at various levels
- Strong analytic assessment skills with ability to problem solve independently as well as demonstrated ability to function as a team member
- Knowledge of process improvement, research methodology and evidence based medicine
- Previous experience with Occupational or Rehabilitation Medicine or similar experience
- Additional Skills/abilities: Adaptability, Critical thinking, Superior written and oral communications, Analytical problem solving, Quality management, and Systems thinking
Required Licensure, Certification, Registration or Designation:
- 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 90 days