Coordinator Clinical Review Unit - MUST live in KPWA market
Primary Location Renton, Washington
Worker Location Flexible
Job Number 1331505 Date posted 01/22/2025
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Description:
Responsible for the overall maintenance of Clinical Review Unit regulatory standards, coordination of Clinical Review Unit workflow, and general management of reviews prior to and after the nurse and physician components. Ensure timely completion of review process, including quality management of all Clinical Review Unit work products, to include denial letters for both Clinical Review Unit activity and Care Management activity. Accountable for all Clinical Review Unit claims-related activity, including management of Options OON and PEC reviews. Coordinate with internal and external customers to ensure timely management of this activity. Maintain a high level of inter-departmental customer service with GH internal customer departments.
Job Summary:
Responsible for the overall maintenance of Clinical Review Unit regulatory standards, coordination of Clinical Review Unit workflow, and general management of reviews prior to and after the nurse and physician components. Ensure timely completion of review process, including quality management of all Clinical Review Unit work products, to include denial letters for both Clinical Review Unit activity and Care Management activity. Accountable for all Clinical Review Unit claims-related activity, including management of Options OON and PEC reviews. Coordinate with internal and external customers to ensure timely management of this activity. Maintain a high level of inter-departmental customer service with GH internal customer departments.
Essential Responsibilities:
- Responsible for managing all incoming and outgoing review data and cases, ensuring compliance with timelines, content of denial and approval files, complete documentation in the associated information systems, and ensures all written communication meets compliance and legibility standards.
- Accountable for all communication (electronic, telephonic, and written), both into and out of the Clinical Review Unit.
- Responsible for all Clinical Review Unit-related claims activity.
- Facilitates all requests for review activity to include those by the WPMG and external delivery system, community networks, and other Kaiser Foundation Health Plan of Washington partners and customers.
Basic Qualifications:
Experience
- Minimum two (2) years of experience in a medical administrative position utilizing MS Office software.
Education
- Bachelors degree OR a minimum four (4) years of experience in a directly related field.
- High School Diploma OR General Education Development (GED) is required.
License, Certification, Registration
- N/A
Additional Requirements:
- Advanced writing skills.
- Organizational and time management skills.
- Communication, analytical, customer service and interpersonal skills.
- Medical terminology.
- Computer skills in a Windows environment to include MS Office, Lotus Notes, IBM Applications, Filenet, IPD, Vantive and Outlook.
Preferred Qualifications:
- Three (3) years of experience in a health plan medical review setting and familiarity with utilization management programs.
Primary Location: Washington,Renton,Renton Administration - Rainier
Scheduled Weekly Hours: 40
Shift: Day
Workdays: Mon, Tue, Wed, Thu, Fri, Sat, Sun
Working Hours Start: 08:00 AM
Working Hours End: 05:00 PM
Job Schedule: Full-time
Job Type: Standard
Worker Location: Flexible
Employee Status: Regular
Employee Group/Union Affiliation: NUE-WA-04|NUE|Non Union Employee
Job Level: Individual Contributor
Department: Renton Admin Rainier - Grp Reltn-Review Svcs Mgt/Supp - 1130
Pay Range: $29.23 - $37.81 / hour
Kaiser Permanente strives to offer a market competitive total rewards package and is committed to pay equity and transparency. The posted pay range is based on possible base salaries for the role and does not reflect the full value of our total rewards package. Actual base pay determined at offer will be based on labor market data and a candidate's years of relevant work experience, education, certifications, skills, and geographic location.
Travel: No
Flexible: Work location is on-site at a KP location, with the flexibility to work from home.
Worker location must align with Kaiser Permanente's Authorized States policy.
At Kaiser Permanente, equity, inclusion and diversity are inextricably linked to our mission, and we aim to make it a part of everything we do. We know that having a diverse and inclusive workforce makes Kaiser Permanente a better place to receive health care, a more supportive partner in our communities we serve, and a more fulfilling place to work. Working at Kaiser Permanente means that you agree to and abide by our commitment to equity and our expectation that we all work together to create an inclusive work environment focused on a sense of belonging and wellbeing.
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
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
