About Us

Washington Permanente Medical Group (WPMG) is a clinician-led, self-governed and independent multi-specialty group practice, providing care to the more than 700,000 Kaiser Permanente patients in Washington state. We work unencumbered by traditional health care obstacles and without silos; prioritizing people over profits, collaboration over ego, and driven by a singular goal: our patients' health. At WPMG, we take care of the whole person, with a team to address the fundamental, social, and emotional needs that contribute to total health. We are clinicians motivated by the desire to make a purposeful difference in the communities we serve, and in how health care is delivered.

Summary

Kaiser Permanente-Washington Permanente Medical Group is seeking a Full Time 1.0 FTE Supervisor, Specialized Medical Ability Resource Program (SMARTeam) - Clinical Reviewer to join our WPMG HQ team in Renton, Washington.

Job Summary

The Supervisor for the Specialized Medical Ability Resource Program (SMARTeam) will provide clinical leadership and oversight to uphold excellence and clinical review competency, of staff, in the provision of nursing clinical review in support of front-line physicians through implementation of the professional practice model and evidence-based standards. This position will be accountable for coordinating RN clinical review functions including the implementation of regionally consistent practices, processes, and protocols within a clinical review department to achieve excellence in quality of care, customer service, resource utilization, and employee satisfaction. The Supervisor will work closely with the Medical Director in fulfilling the job accountabilities.

The position will also perform FMLA clinical review and review of other disability related requests for medical appropriateness to maintain clinical expertise and competency to fulfill job responsibilities. The position will direct the provision of clinical review processes within the department and in accordance with licensure and regulatory requirements.

The Supervisor, SMARTeam serves as a patient communication liaison as needed for complicated cases related to all aspects of the Medical Ability Resource Program, including Leaves of Absence: FMLA (Family Medical Leave Act), WFLA (Washington Family Leave Act), WFCA (Washington Family Care Act), Workers' Compensation, claims under the Americans with Disabilities Act Amendment Act (ADAAA), and employees with non-occupational injuries or illnesses. The key objective is to maintain accurate communication and education of the Medical Ability Resource Program philosophy and regulations.

Principal Duties & Responsibilities

Team Leadership:

• Values the perspectives of diverse stakeholders including clinical teams, patients, and their communities.
• Models inclusive leadership qualities including self-awareness, humility and curiosity.
• Collaborates with the leadership team and brings the professional nursing clinical perspective to improve the quality of review processes related to the determination of medically appropriate time away from work. Ensures Clinical Reviewer working to full scope and/or certification. Collaborates and identifies opportunities to optimize scope of practice and ensure resource stewardship.
• Ensures staff have the required knowledge and skills to perform assignment; provide on-going clinical review skills development; develop processes, implement best practices.
• Monitors outcome metrics ($$/time loss savings) via review process for medical appropriateness. Collaborates with leadership team, stakeholders, and inter-regional counterparts to ensure clinical quality through periodic quality review audits; leads peer review process and identifies and implements remediation process when/if needed. Continuously monitors changes in FMLA laws, ADA, and all other rules, regulations and laws related to FMLA, ADA and other disability related programs.
• Assess urgency of requests for clinical review for the purposes of determining appropriate prioritization and needed actions to assure urgent forms completion.
• Collaborates with Medical Director and key stakeholders to develop recommendations, implementation plans, and evaluative processes for ongoing process improvement related to clinical review.
• Performs continuous surveillance of all relevant State regulations and Federal regulations pertaining to disability related leave including: Leaves of Absence: FMLA (Family Medical Leave Act), WFLA (Washington Family Leave Act) WFCA (Washington Family Care Act), and including other States with shared services, (HI and the Americans with Disabilities Act Amendment Act (ADAAA).
• Supervises and coordinates staff activities necessary to provide excellent member focused medical reviews for clinician approval. Acts as liaison between the Medical Director, and other support departments to ensure effective communication of overall clinical review processes, including regional communications that cascade to frontline staff.
• Selects, coaches, and develops performance management of nursing staff in compliance with requirements of EEO/AA goals and human resource policies. Ensures that RNs continuously focus on identifying and implementing ways to meet/exceed quality and service targets and implement regional initiatives.
• Supports the development, implementation, and sustainability of standard workflows for FMLA and other disability related forms completion processes. Monitors and controls expenditures, overtime, and staffing levels. Maintains current information and ensures that clinical activities and training incorporate all applicable policies, local, state, and federal laws and regulations and accreditation standards included inter regional licenses as required to support shared services.
• Understands the fundamentals of bias and is able to take this into account as a leader.
• Understands the value of diverse teams and demonstrates commitment to diversifying the medical group and leadership.

Operational Leadership:

• Actively builds a culture of equity by understanding health disparities and creating system level interventions to address them.
• Develops cultural competency and agility in self and others in order to understand and respond to the different care experiences faced by our diverse patient population.
• Encourages front line staff to improve care where they work.
• Ensures compliance with related Patient Safety, EH&S regulations, training requirements and regional emergency preparedness expectations. Researches and resolves customer complaints. Supports Medical Director in working collaboratively with physician groups and others in the organization (regionally and inter regionally) as well as with employer groups and other external partners to ensure provision of high quality, patient centered clinical review services.
• Collaborates with leadership team to ensure adoption through training and implementation of procedures designed to impact quality measures as appropriate, i.e., organizational and department-specific quality and continuous improvement goals.
• Prepares assigned team(s) for all KPHC upgrades and enhancements in partnership with the KPHC team.

Supports regional and inter regional projects and committees related to process improvement and sharing of best practices.

Operational Excellence:

• Independently and proactively complete Medical Certifications through medical chart reviews in Epic providing recommendations for time off work to clinicians.
• Recommend time away from work based on clinical judgment supported by relevant tools, utilization of evidence-based guidelines, application of principles of the Medical Ability Resource Program, and input from disability management clinician leads as necessary.
• Assist in providing disability related education and feedback to clinicians with the goal of decreasing the variability in work absence clinical decision making and reducing the administrative burden for clinicians.
• Communicate effectively when working with clinicians to address disability related questions.
• Develop and maintain expertise in federal, state and local disability related regulations and legislation, including, but not limited to FMLA, WPFML, WFLA, WFCA, ADA, etc., as well as Disability Duration Guidelines, and Milliman Criteria. Collaborates in on-going clinical review skills development and implementation of best practices.
• Monitor and track FMLA Medical Certifications and disability forms utilizing secure databases to support continuous clinical quality improvement, eliminating re-work, and improving disability management systems and processes.
• Support WPMG goals and objectives to improve patient care, disability prevention and management.
• Obtain feedback regarding customer service concerns and communicate to appropriate personnel to ensure that identified patient concerns are satisfactorily addressed.

Teamwork and Collaboration:

• Collaborates with Program's Medical Director in clinician education and actively contributes to program development:
  • Collaborate with others in the interdisciplinary healthcare team to ensure that regulatory and compliance standards are met.
  • Participate in quality and inter-rater reliability review activities.
  • Assist with ensuring that regulatory and compliance standards are met in applying disability prevention and management principles.
  • Contribute to the development and updating of disability related training and education materials.
  • Participate in professional committees/task forces as needed/requested.
• Collaborates with Business Office staff (Patient Access Representatives), teams and leads in addressing disability related form completion issues and requests as needed.

Knowledge and Skill Required

Management:

• Demonstrated leadership skills with the ability to direct the activities of others on a direct or matrix team basis.
• Ability to collaborate and be influential across structures and roles.
• Adaptability, critical thinking, superior written and oral communications, analytical problem solving, and quality management.
• Proven ability to establish and maintain effective working relationships at various levels.
• Ability to work effectively with medical staff.
• Demonstrated customer focused service skills.
• Professional written and verbal communication and interpersonal skills.

Delivery System:

• Knowledge of delivery system operations, healthcare delivery systems and trends.

Business Acumen:

• Knowledge of business process and rapid cycle improvement and systems thinking.
• Knowledge of process improvement, research methodology and evidence-based medicine.
• Working knowledge of FMLA/WFLA and ADA guidelines.
• Project Management knowledge and data analytical skills
• Ability to navigate medically relevant databases.
• Ability to handle highly confidential and other information with discretion.
• Experience completing medical chart reviews.
• Proficiency in the use of electronic medical record systems such as Epic.
• Competence with medical record review and analysis.
• Reliable clinical judgment and appropriate application of clinical knowledge related to assessment of appropriate medical care.
• Ability to attend to details, prioritize and complete multiple tasks independently in a fast-paced environment and following agreed upon timeline.
• Demonstrate the ability to identify critical issues, exercise independent judgment and function as a team member.
• Knowledge and experienced user in Microsoft Office software.

Decision Making and Communication:

• Ability to challenge established ways and lead change.
• Demonstrated effective problem solving and decision-making skills. Proven negotiation and conflict resolution skills.
• Strong analytic assessment skills with ability to problem solve independently as well as demonstrated ability to function as a team member.

Benefits

Benefits include: Medical/dental/vision benefits, 401(k) & employer-paid retirement contributions, paid vacation, long-term disability, long-term care benefits.

Community

Renton, with a population of 101,300, is located on the south shore of Lake Washington with spectacular views of the lake, the Olympics, the Cascades, and Mount Rainier. The Cedar River runs through the heart of downtown and offers an abundance of natural beauty and a run of federally endangered chinook salmon. The City is centrally located for access to the regions' transportation network, accessible by four state and three interstate highways, only minutes away from Seattle, Bellevue, Tacoma and Sea-Tac Airport. Renton's strong economic base, diverse marketplace and favorable business climate have attracted the attention of nationally recognized companies that are looking to provide employees and their families with an outstanding quality of life.

We are dedicated to building lifetime relationships with peers and patients in Washington State's richly diverse communities. Many know the Pacific Northwest as an attractive tourist destination with beautiful scenery, friendly people, and a host of cultural and recreational opportunities. These elements, and others, make Washington an excellent place to live.