- Monitors and acts on daily operations of the Clinical Review, Case Management, and Code Review nursing staff using daily management systems.
- Manages and monitors daily work product of the Clinical Review, Case Management and Code Review nursing staff.
- Continuously mentors and coaches staff. Help identify and define tools to perform job duties.
- Monitors and manages staff performance; counsels, hires, and terminates as necessary.
- Monitors and adjusts staffing between Clinical Review and Case Management and cross-functionally with other departments within Pre-Service department based on the need to comply with regulatory standards.
- Minimum two (2) years of prior leadership experience in a clinic or utilization management setting.
- Bachelors degree in nursing.
- Registered Nurse License (Washington) required at hire
- Basic Life Support required at hire
- Effective communication skills.
- Computer skills.
- Knowledge of utilization management; Knowledge of medical benefits adjudication; Use of Milliman clinical criteria; Some knowledge of appropriate coding requirements.
- Some knowledge of state, federal, NCQA, and CMS regulatory requirements related to pre-authorization.
- Working knowledge of authorization processing procedures and post service claims processing procedures.
- Thorough knowledge of utilization management and medical benefits adjudication; Direct experience using Milliman clinical criteria.
- Direct knowledge of appropriate coding and billing requirements.
- Thorough knowledge and experience using state, federal, NCQA, and CMS regulatory requirements.
-
CRNA Locum in Washington State
4 days ago
Access Healthcare Staffing Solutions Spokane, United StatesJob Description · General anesthesia, some spinal anesthesia, neuro, ortho, some vascular, some arterial line placement. · 3 shift minimum/week (will schedule 8-12 hour days dependent on scheduled procedures); flexible scheduling is ok,but need to be available every week.No wee ...
-
Ascend Medical Staffing Spokane, United StatesAre you available to work on a locum contract this year? A hospital based clinic practice is seeking an occupational medicine physician to work on a locum basis this summer. · Start Date: June 12, 2023 · End Date: September 8, 2023 · Reason: Medical Leave · Location: Spokane, ...
-
Ascend Medical Staffing Spokane, United StatesAre you available for anesthesiology locum coverage this year starting in June? · A hospital in Spokane, WA is seeking anesthesiology locum coverage in 2022 · Start Date: June 2022 or when you can start · End Date: Ongoing · General, Head and Spine · $300+ per hour dependent ...
-
Kaiser Permanente Spokane, United States Full time: MUST LIVE IN WASHINGTON STATE OR IDAHO · Job Summary: · Directs the daily operations of Clinical Review nurses, Case Management nurses, and Code Review nursing staff. Ensures appropriate staffing levels to accomplish established regulatory parameters, customer service, qualit ...
-
Assistant or Associate Professor
3 weeks ago
Washington State University Spokane, United States Full timeAvailable Title(s): · 270-NN_FACULTY - Assistant Professor, 280-NN_FACULTY - Associate Professor Business Title: · Assistant or Associate Professor - College of Nursing - WSU Employee Type: · Faculty Time Type: · Full time Position Term: · 9 Month - Summer Position Deta ...
-
Washington State University Spokane, United StatesThe Department of Community and Behavioral Health (CBH), Elson S. Floyd College of Medicine, Washington State University Health Sciences Spokane, WA invites applications for multiple permanent, full-time, tenure-track, 12-month annual Assistant or As Behavioral Health, Public Hea ...
-
State of Washington Spokane, United StatesSalary: $ $26.45 Hourly · Location : Spokane County - Spokane, WA · Job Type: On-Call · Job Number: · Department: Dept. of Veterans Affairs · Division: Spokane Veterans Home · Opening Date: 06/13/2024 · Closing Date: 7/11/2024 11:59 PM Pacific · Description · Nursing Assi ...
-
Data Consultant 1
1 week ago
State of Washington Spokane, United StatesSalary: $3, $4,842.00 Monthly · Location : Spokane County - Spokane, WA · Job Type: Full Time - Permanent · Job Number: · Department: Military Department · Division: Air Guard · Opening Date: 05/28/2024 · Closing Date: 6/11/2024 11:59 PM Pacific · Description · Data Consu ...
-
Public Benefits Specialist 1
2 days ago
State of Washington Spokane, United StatesOur vision is to ensure that Washington states children and youth grow up safe and healthythriving physically, emotionally and academically, nurtured by family and community."Job Title: Public Benefits Specialist 1-3 In-Training (PBS 3)Location: S Benefits Specialist, Benefits, S ...
-
Data Consultant 1
5 days ago
State of Washington Spokane, United StatesData Consultant 1 · Spokane, WA · Reporting to the Maintenance Specialist 4, this position is responsible for performing a variety of production control processes including data entry, programs, planning, and expediting work tasks in direct support of assigned facilities and Real ...
-
Home Study Specialist 3
1 week ago
State of Washington Spokane, United StatesOur vision is to ensure that Washington states children and youth grow up safe and healthythriving physically, emotionally and academically, nurtured by family and community." Job Title: Home Study Specialist 3 (SSS 3)Location: Spokane, WA - This Specialist, Behavioral, Social Se ...
-
Washington State University Spokane, United StatesThe Washington State University College of Nursing (CON) is seeking a new team member who is excited to play a vital role in clinical experiences for nursing students. The Clinical Contract Coordinator manages the clinical training agreement (CTA) li Clinical, Contracts, Coordina ...
-
Home Study Specialist 3
4 weeks ago
State of Washington Spokane, United StatesOur vision is to ensure that "Washington state's children and youth grow up safe and healthy—thriving physically, emotionally and academically, nurtured by family and community." · Job Title: · Home Study Specialist 3 (SSS3) · Location: · Spokane · , WA - This position is Fl ...
-
State of Washington Spokane, United StatesALTSA HCS Public Benefits Specialist 4 In-Training Do you want a career helping others? Consider this exciting opportunity Home and Community Services is currently seeking a Public Benefits Specialist in Spokane, Washington. As an In-Training Public Benefits Specialist, Training, ...
-
DSHS ALTSA Social Service Specialist 3
5 days ago
State of Washington Spokane, United StatesDSHS Adult Protective Service Investigator Adult Protective Services is excited to have Social Service Specialist 3 in-training (SSS 1 or SSS 2 opportunities for professionals with investigative skills to join our team as Investigative Social Service Specialist, Service, Retail · ...
-
Project Manager, College of Medicine
1 week ago
Washington State University Spokane, United StatesThe project manager works collaboratively with the Senior Director of Strategic Management (SDSM) to coordinate and perform project management tasks for the implementation of the colleges 5-year strategic plan. The project manager works collaborativ Project Manager, Manager, Proj ...
-
DSHS DVR Vocational Rehabilitation Counselor
1 week ago
State of Washington Spokane, United StatesDSHS DVR Vocational Rehabilitation Counselor 3 The job of Vocational Rehabilitation Counselor is suited for the person that has a commitment to the economic prosperity of Students, Youth and Adults with disabilities who are seeking good-paying jobs a Vocational, Rehab, Rehab, Cou ...
-
Events Coordinator, College of Medicine
1 week ago
Washington State University Spokane, United StatesThe Events Coordinator is responsible for planning, arranging, and coordinating facility and logistical support for all on- and off-site events sponsored by and in collaboration with offices within the Elson S. Floyd College of Medicine. This role wi Events Coordinator, Medicine, ...
-
ASL Senior Engineer
1 week ago
Washington State University Spokane, United StatesASL Senior Engineer · Available Title(s): · 1427-NN_ADMINPRO - Research Project Engineer Senior · Business Title: · ASL Senior Engineer · Employee Type: · Admin. Professional (+) (Fixed Term) · Time Type: · Full time · Position Term: · 12 Month · Position Details: · Summary of Du ...
-
DSHS DVR Vocational Rehabilitation Counselor
2 weeks ago
State of Washington Spokane, United StatesSalary: $47, $74,376.00 Annually · Location : Spokane County - Spokane, WA · Job Type: Full Time - Permanent · Remote Employment: Flexible/Hybrid · Job Number: · Department: Dept. of Social and Health Services · Division: DVR · Opening Date: 05/29/2024 · Closing Date: 6/1 ...
Supervisor - Clinical Review (Full-time - Salaried/Exempt) Washington State - Spokane, United States - Kaiser
Description
MUST LIVE IN WASHINGTON STATE OR IDAHOJob Summary:
Directs the daily operations of Clinical Review nurses, Case Management nurses, and Code Review nursing staff. Ensures appropriate staffing levels to accomplish established regulatory parameters, customer service, quality and productivity goals. Ensures that authorization requests sent to Prior Authorization and identified post service claims are reviewed according to appropriate regulatory, coverage and clinical criteria guidelines. Ensures reviews are done in accordance with state, federal, NCQA and CMS guidelines for timeliness and documentation. Manages staff performance by using performance management tools and providing effective coaching/mentoring. Manages department workloads using daily management systems. Provides appropriate tools and training to staff, and provides timely feedback and documentation through staff meetings and one-on-one meetings. Takes appropriate disciplinary action including counseling, performance improvement plans, etc. In consultation with and under the direction of the Pre-Service Manager, hires and terminates staff as necessary.
Essential Responsibilities:HoursPerWeek : 40
Shift : Day
Workdays : Mon, Tue, Wed, Thu, Fri
WorkingHoursStart : 08:00 AM
WorkingHoursEnd : 05:00 PM
Job Schedule : Full-time
Job Type : Standard
Employee Status : Regular
Employee Group/Union Affiliation : NUE-WA-04|NUE|Non Union Employee
Job Level : Team Leader/Supervisor
Job Category : Nursing Licensed & Nurse Practitioners
Department : Renton Admin Rainier - Grp Reltn-Review Svcs Mgt/Supp
Travel : No
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.
