Administrative Utilization Management Physician - Policy Focus

Northwest Permanente; Portland (OR); Sur place; USD 180 000 - 320 000; Plein temps

Avantages offerts par ce poste

Pension plan

Comprehensive benefits

Paid education leave

Résumé du poste

Northwest Permanente is seeking a full-time Utilization Management Physician to determine medical necessity for Kaiser Permanente members, applying clinical judgment and established guidelines. The role involves administrative responsibilities within a physician-led group in Oregon, with emphasis on policy adherence and high-stakes decision-making.

The position requires board certification, state licensure in Oregon and Washington, and substantial experience in clinical practice plus utilization

Qualifications

• Board-certified MD or DO required.
• Current unrestricted medical licensure in Oregon and Washington.
• Minimum five (5) years of clinical practice.
• Minimum two (2) years of utilization management experience.

Responsabilités

• Conduct daily utilization management medical necessity reviews and coverage assessments based on member information, plan benefits, and applicable policies.
• Participate in over-the-phone hearings with Administrative Law Judge for adverse determinations.
• Provide initial training and ongoing education to utilization management staff.
• Maintain knowledge of regulatory requirements and participate in inter-rater reliability sessions.
• Conduct pre-registration calls to obtain authorizations from non-Kaiser Permanente insurers for imaging and procedures.

Formation

Board-certified MD or DO

Description du poste

Northwest Permanente is seeking a full-time Utilization Management Physician to determine medical necessity for Kaiser Permanente members, applying clinical judgment and established guidelines. The role involves administrative responsibilities within a physician-led group in Oregon, with emphasis on policy adherence and high-stakes decision-making.

The position requires board certification, state licensure in Oregon and Washington, and substantial experience in clinical practice plus utilization