Chronic Condition Reviewer (RN)Office: Process Center
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. We are seeking a Chronic Condition Review Nurse to join our Financial Health Department, reporting to the NWP Director of Risk Adjustment and the NWP Regional Risk Adjustment Physician Lead. The Chronic Condition Review (CCR) RN is responsible for serving as a clinical resource to Northwest Permanente (NWP) physicians in improving the quality and completeness of the Kaiser Permanente Health Connect (KPHC) Patient Problem List (PL). The CCR RN will 1) investigate diagnoses included in medical claims from internal and external sources and determine their validity, 2) complete comprehensive nursing reviews of patient medical records prior to a patient’s upcoming appointment, and 3) other duties as assigned.
MAJOR RESPONSIBILITIES / ESSENTIAL FUNCTIONS:
- Responsible for investigating internal and external claims to determine whether diagnoses made at Kaiser Permanente (KP) and non-KP facilities are accurate and should be added to the KPHC Patient PL.
- Identify supporting evidence (i.e., radiology/cardiology and lab results, specialty care and Care Everywhere documentation, etc.), which will either be added to the patient PL by the CCRN, suspected to the Provider for review, or dismissed as inaccurate or inappropriate.
- Complete comprehensive nursing assessment of the patient’s medical record prior to clinic appointments. Assessment includes collecting and evaluating data through the application of scientific evidence, practice experience, and nursing judgment.
- Through the comprehensive nursing assessment, the CCR RN will determine whether there are chronic conditions or clinically significant diagnoses that should be added to the PL.
- Identify supporting evidence (radiology/cardiology and lab results, specialty care and Care Everywhere documentation, etc.) which will either be 1) directly added to the patient PL by the CCR RN, 2) suspected to an in-house Medical Reviewer for further investigation, or 3) suspected to the Provider for review with the patient during the upcoming appointment.
- Participates in department and regional meetings as requested.
- Other duties as assigned.
MINIMUM EDUCATION & WORK EXPERIENCE
- Bachelor's degree in Nursing
- Five (5) years of work experience as an RN
- Strong knowledge and understanding of pathophysiology, disease process, and clinical documentation.
- Proficiency in using health record to conduct comprehensive assessments, including collecting and evaluating data.
- Ability to work independently and problem solve.
- Ability to function as a team member consistently following CEO principles.
- Ability to establish and maintain effective working relationships at various levels.
- Ability to handle highly confidential and other information with discretion.
- Ability to navigate medically relevant databases.
- Proficiency in the use of electronic medical record systems such as Health Connect.
- Professional written and verbal communication and interpersonal skills.
- Experienced user in basic Microsoft Office software
- Must be able to telecommute full time.
REQUIRED LICENSURE. CERTIFICATION, REGISTRATION (LCR):
- Current RN license in Oregon and Washington. Requires Oregon or Washington license at time of hire. Licenses in both states are required within 6 months of hire/transfer with submitted application required within 2 weeks of hire/transfer.
- Master's degree in Nursing
PREFERRED WORK EXPERIENCE & QUALIFICATIONS:
- Ten (10) years of work experience as a RN
- Three (3) years as a RN in Kaiser Permanente.
- Previous experience with acute discharge planning or inpatient care coordination.
- Previous experience with inpatient adult medicine or critical care.
- Previous experience in utilization management and/or case management.
- Previous experience in quality improvement and use of CQI tools and techniques.
- Proven ability to establish and maintain effective working relationships at various levels.
- Strong analytic assessment skills with ability to problem solve independently
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.