Utilization Management Physician - Shareholder Path

Southern California Permanente Medical Group; Portland (OR); On-site; USD 200,000 - 260,000; Full time

Benefits offered by this job

Pension plan

Paid education leave

Employer-funded benefits

Job summary

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.

Qualifications

• 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.

Responsibilities

• 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.

Skills

Utilization management

Clinical judgment

Evidence-based guidelines

Regulatory knowledge

Education

Board-certified MD or DO

Unrestricted license in OR & WA

Job description

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.