Part-Time Specialty Pharmacy Case Reviewer

Virginia Foundation for Healthy Youth; Renton (WA); On-site; USD 120,000 - 160,000; Part time

Job summary

Kaiser Permanente Washington Permanente Medical Group is seeking a part-time provider to support SHARP, peer review, and medication safety. You will review new drug starts, discuss treatment options with specialists, and adjudicate coverage requests using established criteria.

In collaboration with KPWA Pharmacy staff, you will document decisions, manage appeals, and provide education to stakeholders while ensuring timely, clinically appropriate coverage within regulatory timelines.

Qualifications

• MD or DO with board certification in the required specialty.
• Current unrestricted Washington State license or eligible.
• Credentialed by KPWA and able to meet WPMG performance standards.
• Completion of residency and fellowship in the required specialty.
• Documentation of additional training in health plan review, utilization management and quality programs.

Responsibilities

• Collaborate with pharmacists, RNs and case managers to facilitate appropriate specialty level of care for KPWA patients.
• Develop clinical review criteria and programs in the appropriate specialty.
• Document review processes and decisions with rationale for patient and provider communications.
• Coordinate opinions with subspecialty clinicians within WPMG or KP regions and preferred partners.
• Provide education and feedback to medical directors and care management on criteria and outcomes.

Skills

Leadership

Collaboration

Communication

Decision Making

Problem Solving

Education

MD

Board Certified by ABMS or ACPE

Certificate of Medical Management

MBA/MHA/MPH - health administration or related field

Completion of approved residency program

Completion of an accredited fellowship in required specialty

Documentation of additional training in health plan review, utilization management and quality programs

Job description

Kaiser Permanente Washington Permanente Medical Group is seeking a part-time provider to support SHARP, peer review, and medication safety. You will review new drug starts, discuss treatment options with specialists, and adjudicate coverage requests using established criteria.

In collaboration with KPWA Pharmacy staff, you will document decisions, manage appeals, and provide education to stakeholders while ensuring timely, clinically appropriate coverage within regulatory timelines.