The Chronic Condition Review (CCR) RN is responsible for serving as a clinical resource to Northwest Permanente physicians in improving the quality and completeness of chronic condition for Kaiser Permanente members. This role works to ensure Kaiser Permanente Northwest receives appropriate reimbursement and conforms to applicable guidelines and regulations. The CCR RN will 1) investigate diagnoses included in medical claims from internal and external sources and determine their validity, 2) complete comprehensive nursing reviews of patient medical records prior to a patient’s upcoming appointment, 3) Participate in and develop clinical diagnosis confirmation reviews, 4) Assist in regulatory audits, and 5) other duties as assigned.
Primary Responsibilities:
- Identifies supporting evidence of diagnoses (i.e., radiology/cardiology and lab results, specialty care and Care Everywhere documentation, etc.), which will either be added to the patient Problem List (PL) by the CCR RN, suspected to the Provider for review, or dismissed as inaccurate or inappropriate.
- Applies strong coding knowledge and understanding of Risk Adjustment models and submission guidelines for reportable diagnoses.
- Responsible for investigating internal and external claims to determine whether diagnoses made at Kaiser Permanente and non-Kaiser Permanente facilities are accurate and should be added to the Patient PL.
- Completes comprehensive nursing assessment of the patient’s medical record prior to clinic appointments. Assessment includes collecting and evaluating data through the application of scientific evidence, practice experience, and nursing judgment.
- Assists with performing/conducting regulatory audits to provide expertise and review.
- Provides ongoing reviews of CDC algorithms for effectiveness and efficiency.
- Collaborates with internal and external stakeholders to ensure data, documentation and coding meet regulatory guidelines.
Qualifications:
- Bachelor’s degree in nursing.
- Minimum five (5) years of work experience as an RN.
- Current RN license in Oregon and Washington. Requires Oregon or Washington license at time of hire. Licenses in both states are required within 6 months of hire/transfer with submitted application required within 2 weeks of hire/transfer.
- One (1) year medical coding with ICD-10 or similar experience highly preferred.
- Strong knowledge and understanding of pathophysiology, disease process, and clinical documentation.
- Proficiency in using health record to conduct comprehensive assessments, including collecting and evaluating data.
- Ability to handle highly confidential and other information with discretion.
- Proficiency in the use of electronic medical record systems such as Epic. Ability to navigate medically relevant databases.
- Certified Risk Adjustment Coder (CRC) from AAPC preferred.
About Northwest Permanente:
We are the Permanente in Kaiser Permanente. Northwest Permanente is a self-governed, multi-specialty group of 1,500 physicians, clinicians, and administrative professionals caring for more than 615,000 members in Oregon and Southwest Washington. Together with Kaiser Foundation Health Plans and Kaiser Foundation Hospitals, we form Kaiser Permanente of the Northwest, an integrated health care program. Kaiser Permanente is one of the nation's preeminent health care systems, a benchmark for comprehensive, integrated, value-based, and high-quality care.
Our Northwest Permanente administrative professionals enjoy a wide range of company sponsored benefits:
- 15% employer contribution to retirement programs, including pension
- 90% employer-paid health plan
- Tuition Reimbursement
- Child Care Benefits
- Flexible Work Schedules
- Paid Parental Leave
- Self-Care Days + Paid Time Off
For more information about this position, contact Marisa Walter, marisa.e.walter@kp.org.
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.
