Prior Authorization RN Reviewer (Must Live in WA/OR)

Portland, Oregon
Apr 20, 2024
Apr 30, 2024
Job Summary:

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.

Essential Responsibilities:

  • 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.

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