Clinical Reviewer, Specialized Medical Ability Resource Program
Kaiser Permanente-Washington Permanente Medical Group
March 14, 2018
The Clinical Reviewer for the Specialized Medical Ability Resource Program is an active member of the Specialized Medical Ability Resource Team (SMARTeam), who provides centralized medical chart reviews services, including but not limited to standardized processes for reviewing medically necessary time away from work and other disability form requests. The SMARTeam Clinical Reviewer serves as a clinical resource to WPMG clinicians for disability related form completion requirements and certifications (e.g. FMLA/ADA, etc.) This position also includes serving as patient communication liaison as needed for complicated cases related to all aspects of the Medical Ability Resource Program, including Leaves of Absence: FMLA (Family Medical Leave Act), WFLA (Washington Family Leave Act), WFCA (Washington Family Care Act), Workers' Compensation, claims under the Americans with Disabilities Act Amendment Act (ADAAA), and employees with non-occupational injuries or illnesses. The key objective is to maintain accurate communication and education of the Medical Ability Resource Program philosophy and regulations.
PRINCIPAL DUTIES & RESPONSIBILITIES
Independently and proactively complete Medical Certifications through medical chart reviews in Epic providing recommendations for time off work to clinicians.
Recommend time away from work based on clinical judgment supported by relevant tools, utilization of evidence based guidelines, application of principles of the Medical Ability Resource Program, and input from disability management clinician leads as necessary.
Assist in providing disability related education and feedback to clinicians with the goal of decreasing the variability in work absence clinical decision making and reducing the administrative burden for clinicians.
Communicate effectively when working with clinicians to address disability related questions.
Develop and maintain expertise in federal, state and local disability related regulations and legislation, including, but not limited to FMLA, WFLA, WFCA, ADA, etc., as well as Disability Duration Guidelines, and Milliman Criteria. Collaborates in on-going clinical review skills development and implementation of best practices.
Monitor and track FMLA Medical Certifications and disability forms utilizing secure databases to support continuous clinical quality improvement, eliminating re-work and improving disability management systems and processes.
Support WPMG goals and objectives to improve patient care, disability prevention and management.
Obtain feedback regarding customer service concerns and communicate to appropriate personnel to ensure that identified patient concerns are satisfactorily addressed.
Collaborates with Program's Medical Director in clinician education and actively contributes to program development:
Collaborate with others in the interdisciplinary healthcare team to ensure that regulatory and compliance standards are met.
Participate in quality and inter-rater reliability review activities.
Assist with ensuring that regulatory and compliance standards are met in applying disability prevention and management principles.
Contribute to the development and updating of disability related training and education materials.
Participate in professional committees/task forces as needed/requested.
Collaborates with Business Office staff (Patient Access Representatives), teams and leads in addressing disability related form completion issues and requests as needed.
Other duties as assigned.
Bachelor's degree in nursing
NP degree in family practice
MD, DO, or PA
Master's degree in Nursing, MHA or MPH
Master of Science in Nursing of Nurse Practitioner Master
Current Washington RN License
Current Washinton ARNP
MD, DO, or PA-C
3 or more years:
Working knowledge of FMLA/WFLA and ADA guidelines.
Ability to work effectively with medical staff.
Demonstrated customer focused service skills.
Ability to navigate medically relevant databases.
Ability to handle highly confidential and other information with discretion.
Experience completing medical chart reviews.
Proficiency in the use of electronic medical record systems such as Epic.
Professional written and verbal communication and interpersonal skills.
Competence with medical record review and analysis.
Reliable clinical judgment and appropriate application of clinical knowledge related to assessment of appropriate medical care.
Ability to attend to details, prioritize and complete multiple tasks independently in a fast-paced environment and following agreed upon timeline.
Demonstrate the ability to identify critical issues, exercise independent judgment and function as a team member.