Utilization Management Physician

Southern California Permanente Medical Group; Portland (OR); Presencial; USD 200.000 - 260.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Pension plan

Paid education leave

Employer-funded benefits

Descripción de la vacante

Northwest Permanente, located in the Portland metro area, seeks a full-time Utilization Management Physician. The role requires board certification and unrestricted licenses in OR and WA, with at least five years of clinical practice and two years in utilization management.

You will render medical necessity determinations, participate in hearings for state programs, and train staff while staying current with relevant regulations and policies.

Formación

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

Responsabilidades

• Conduct daily utilization management medical necessity reviews and coverage reviews based on member information, plan benefits, policies, and guidelines, and render determinations including authorizations and adverse determinations.
• Participate in over-the-phone hearings with Administrative Law Judge for Oregon Health Plan coverage.
• Provide initial training and ongoing education to utilization management staff and physicians.
• Maintain knowledge of regulatory requirements relevant to utilization management and participate in inter-rater reliability sessions.
• Conduct pre-registration calls to obtain authorizations for imaging and procedures performed at Kaiser Permanente.

Conocimientos

Utilization management

Clinical judgment

Evidence-based guidelines

Regulatory knowledge

Educación

Board-certified MD or DO

Unrestricted license in OR & WA

Descripción del empleo

Utilization Management Physician# Utilization Management Physician## Location: Portland Metro Area, OR - Kaiser Permanente Bldg## Schedule: Full-time**Minimum Education, Licenses and Experience:*** Board certified MD or DO. Current unrestricted medical licensure in Oregon and Washingon.* Minimum five (5) years of clinical practice.* Minimum two (2) years of utilization management experience.**Our Northwest Permanente physicians enjoy:*** Generous automatic employer-funded pension and retirement contributions totaling 21% of eligible clinician earnings with additional employee contribution optional.* Competitive compensation that is not based on fee-for-service model.* Pathway for physicians to become shareholders of Northwest Permanente.* Paid annual education leave + annual education allowance.* Comprehensive benefits including largely employer-funded medical, dental insurance premiums, life insurance, and paid leave.**About Northwest Permanente:**Northwest Permanente (NWP) is the largest multispecialty medical group in Oregon and southwest Washington with more than 1,300+ physicians and 300+ administrative professionals caring for over 600,000 Kaiser Permanente members. Northwest Permanente is owned and led by physicians who earn competitive salaries, without income based on providing individual services. Our medical group comprises board-certified physicians across 50+ specialties.**Equal Opportunity Employer**Northwest Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status.The Utilization Management Physician makes coverage determinations about requested services included in Kaiser Permanente members' benefits packages by exercising clinical judgment, supported by established guidelines and key criteria to determine medical necessity. This position is a full-time administrative physician role.**Major Responsibilities:*** Conducts daily utilization management medical necessity reviews and coverage reviews based on individual member's clinical information, plan benefits, national, state, CMS and proprietary coverage policies, evidence-based references and/or expert opinion and renders determinations including authorizations and adverse determinations.* Participates in over-the-phone hearings with Administrative Law Judge regarding adverse determinations for members with Oregon Health Plan coverage. Conducts peer to peer calls, when requested, on adverse determinations.* Provides initial training and ongoing education to, and in collaboration with, utilization management physicians, nurses and support staff.* Maintains ongoing knowledge of regulatory requirements relevant to utilization management and participates in inter-rater reliability sessions.* Conducts pre-registration calls to obtain authorizations from non-Kaiser Permanente insurance companies for imaging and procedures to be performed at Kaiser Permanente.