Clinical Utilization Review Physician

Southern California Permanente Medical Group; Renton (WA); On-site; USD 110,000 - 190,000; Full time

Job summary

Washington Permanente Medical Group in Renton, WA seeks a Clinical Reviewer to adjudicate coverage requests using established criteria and documentation. Responsibilities include processing referrals, ensuring regulatory timelines, and collaborating with care management teams.

The role requires a medical degree (MD/DO) with residency in internal or family medicine and Washington licensure; knowledge of utilization management and quality programs is preferred.

Qualifications

• Medical degree (MD or DO) required.
• Residency in internal or family medicine.
• Licensure in Washington with appropriate board certification.
• Additional training in health plan review, utilization management and quality programs preferred.

Responsibilities

• Conducts clinical reviews on potential coverage denials using established criteria.
• Document review process and decisions with rationale for patient and provider communication.
• Coordinate with external delivery systems on referral and review processes.
• Manage standard and expedited appeals within regulatory timelines.
• Participate in administrative hearings as needed.
• Apply knowledge of hospital management, case management and utilization review.

Skills

Clinical review

Documentation

Appeals management

Regulatory standards

Quality management

Communication with care management

Team collaboration

Hospital care levels

Education

MD or DO

Internal/Family Medicine residency

Certifications: MBA/MHA/MPH

Job description

Washington Permanente Medical Group in Renton, WA seeks a Clinical Reviewer to adjudicate coverage requests using established criteria and documentation. Responsibilities include processing referrals, ensuring regulatory timelines, and collaborating with care management teams.

The role requires a medical degree (MD/DO) with residency in internal or family medicine and Washington licensure; knowledge of utilization management and quality programs is preferred.