Prior Authorization RN Reviewer (Must Live in WA/OR)
Portland, OregonAt Kaiser Permanente our nurses are leaders, clinicians, researchers, innovators, and scientists who are contributing toward being an industry-leading voice for advancing evidence-based care. Whether supporting the patient directly in our hospitals or clinics, providing care at home, serving our patients through innovative virtual technology, or managing care delivery teams, Kaiser Permanente nurses utilize scientific evidence and our integrated care model to optimize the total health of our members and the communities we serve. We invite nurses who are passionate about nursing excellence, high-quality compassionate care delivery, professionalism, integrity, teamwork and patient and family centeredness to join our teams so that we can continue to sustain and build upon our culture of excellence.
- Job Type: Full-time
- Job Level: Individual Contributor
- Travel: No
Success Profile
We’re looking for Nurse Leaders who possess the following traits.
- Collaborative
- Compassionate
- Flexible
- Leadership
- Socially Conscientious
- Trustworthy
Benefits
We offer several benefits to our nurses.
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Medical, Vision & Dental
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Retirement Plans
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Educational Opportunities & Tuition Reimbursement
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Supportive Teams & Resources
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Career Growth & Development
Our Culture
At Kaiser Permanente, we cultivate an environment of compassion, integrity, trust, and open communication that helps our teams do their best work. We believe that lifelong learning will expand our knowledge so we can better serve our patients. Our practice is rooted in research and evidence-based care. Our nurses reflect the rich diversity of our members and communities and provide culturally responsive and competent care that promotes understanding of our members needs and preferences. At Kaiser Permanente, nurses are highly skilled professionals who exemplify leadership, critical thinking, and collaborative problem solving and deliver the right care, at the right time, in the right setting.
What Our People Are Saying
Kristen
Relief Charge Nurse
“Working as a nurse at Kaiser Permanente has allowed me the perfect flexible schedule so that I can volunteer as Girl Scout Leader and room parent for both my children. My kids know that I am a hardworking mother who can provide, as well as a mom who can be present and be there for them – and that means everything to me.”
Jazmin
RN, Advice Nurse
“Working for Kaiser Permanente has allowed me to take control of my future and make my goals a possibility. I feel that Kaiser Permanente allows me to keep climbing and moving. Having that ability truly makes me feel empowered.”
Stella
Registered Nurse IV
“Kaiser Permanente has taken me on a personal and educational growth journey. I am supported by a culture of excellence that allows me to be dedicated to patients and patients’ families every day at work. What an honor to be part of Kaiser Permanente.”.
Caitlin
Inpatient Lactation Consultant
“As an RN/IBCLC in Maternal Child, I’m meeting families at a pivotal time — I’m there to help launch a new family into the world. Everything I do has the potential to impact a family’s health for generations to come.”
Kimberly
Quality Coordinator RN
“In Hawaii, your community is your family — or ‘ohana.’ I am able to provide extraordinary patient-centered care to my ohana.”
David
Appointment and Advice RN
“The location is fantastic. Kaiser Permanente is all over the country. You can pick almost any environment you want – from ocean to mountain to city. You’ll still be able to contribute to our mission of providing high quality health care at a local facility.”
Shawn
BSN, RN
“I chose Kaiser Permanente because their staff and providers really show that they care about you. Also, throughout my 12 years of working here I’m always learning something new, and I’ve had many opportunities for growth and development.”
Prior Authorization RN Reviewer (Must Live in WA/OR)
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To assist NWP clinicians, KPNW members and community clinicians in the coordination of medical services between Kaiser Permanente and community providers and facilities. Includes interfacing with NWP clinicians, community providers and members to ensure the member receives high quality, safe, efficient and timely medical services.
- Preview and preapprove requests for referral to community clinicians and/or programs for medically necessary services as requested by the NWP clinician.
- Work directly with the member and the community clinician to coordinate medical services within KPNW, providing accurate and timely information to the community physician and member related to requested services.
- Maintain knowledge base of resources available within the community and Kaiser Permanente assists with arranging for medical services in the appropriate location.
- With Community Medicine Integration Center leadership, insures compliance with regulatory and accrediting requirements for utilization of referred services, including NCQA, MDQR, Federal and State agencies.
- Maintains knowledge of Kaiser Permanente policies, procedures and benefits.
- Minimum two (2) years experience as a Registered Nurse.
- High School Diploma or General Education Development (GED) required.
- This job requires credentials from multiple states. Credentials from the primary work state are required before hire. Additional Credentials from the secondary work state(s) are required post hire.
- Registered Nurse License (Washington) within 6 months of hire OR Compact License: Registered Nurse within 6 months of hire
- Registered Nurse License (Oregon) within 6 months of hire
- Demonstrated customer focused service skills.
- Demonstrated ability to assimilate technical information.
- Ability to maintain effectiveness in a busy health care environment.
- Ability to work effectively with all medical staff.
- Ability to assess complex clinical management situations, synthesize data, develop and implement action plans.
- Ability to handle highly confidential and other information with discretion.
- Progressively responsible, broad based experience with health care management.
- Demonstrated skills negotiating and communicating with physicians and other health care providers to assist with the coordination of services to appropriate sites and levels of care.
- Working knowledge of computer systems and medical care delivery systems.
- Minimum two (2) years of work experience as a Registered Nurse within Kaiser Permanente.
- Experience in inpatient and outpatient settings within Kaiser Permanente.
- Working knowledge of electronic clinical information systems, including HealthConnect and Results Reporting.
- Working knowledge of regulatory and accreditation requirements related to health care and health maintenance organizations.
- Comprehensive knowledge of Northwest Permanente and Kaiser Health Plan policies, procedures, personnel, goals, objectives, data systems and organizational structure.
- Bachelors degree in nursing or related field preferred.
Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status. Submit Interest
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