Part-Time Specialty Pharmacy Coverage Review Specialist

Southern California Permanente Medical Group; Renton (WA); On-site; USD 15,000 - 19,000; Part time

Job summary

Kaiser Permanente Washington Permanente Medical Group is seeking a part-time provider (0.1 FTE) to support SHARP, Peer Review and Medication Safety. In partnership with KPWA Pharmacy staff, you will review select new drug starts and discuss options with the member’s specialist, aligning with KP clinical pathways.

You will adjudicate coverage requests, applying standard criteria and gathering relevant data. Collaboration with regional directors and care management is essential to ensure timely,

Qualifications

• Medical degree is required.
• Board certification by ABMS or equivalent.
• Washington state license or eligibility.
• Experience in health plan review, utilization management and quality programs preferred.

Responsibilities

• Review select new drug starts and discuss options with specialists as needed.
• Ensure coverage requests are adjudicated using standard criteria and documented evidence.
• Provide education and feedback to medical directors and care management on review outcomes.
• Coordinate with subspecialists and regions for expert opinions and appropriate care.

Skills

Clinical experience

Utilization review

Medical leadership

Team collaboration

Education

MD/DO

Fellowship

Residency

Utilization training

Certificate in Medical Management

MBA/MHA/MPH

Tools

ACHIEVEMENT

Job description

Kaiser Permanente Washington Permanente Medical Group is seeking a part-time provider (0.1 FTE) to support SHARP, Peer Review and Medication Safety. In partnership with KPWA Pharmacy staff, you will review select new drug starts and discuss options with the member’s specialist, aligning with KP clinical pathways.

You will adjudicate coverage requests, applying standard criteria and gathering relevant data. Collaboration with regional directors and care management is essential to ensure timely,