• Chronic Condition Reviewer (RN)

    Region
    Portland Metro Area
    Full/Part Time
    Full Time
    Req ID
    4216
  • Overview

    Northwest Permanente, P.C. is a self-governed (physician led), multi-specialty group of over 1500 physicians, surgeons, and clinicians, caring for over 600,000 members in Oregon and Southwest Washington. Kaiser Permanente is one of the nation's pre-eminent health care systems, a benchmark for comprehensive, integrated and high quality care.  are seeking a Chronic Condition Review Nurse to join our Financial Health Department, reporting to the NWP Director of Financial Health and the NWP Regional Risk Adjustment Physician Lead. This position will review outside unique claims and comprehensive reviews of patients. This work will be reviewed by MD reviewers for diagnoses that can be added to the problem list, decreasing work for the primary care clinician.

    Responsibilities

    • Review outside unique claims to validate diagnoses. This position will remove, if inaccurate, or pend/leave in the Refresh or Suspect box for review by a clinician in a face-to-face visit. The position will add supporting evidence for the diagnosis (date of CT scan, lab values, etc.).
    • Perform comprehensive reviews of patients in a risk adjusted model. This position will validate diagnoses and pend suspected diagnoses for clinicians to review in a face-to-face visit. The suspect diagnoses will have supportive evidence and be available in the PST suspect box. They will also remove resolved diagnoses.
    • Other duties as assigned.

     REQUIREMENTS:

    • Bachelor of Science in health related field or BSN
    • Minimum five (5) years of acute and/or ambulatory nursing experience OR three (3) years of acute and/or ambulatory nursing experience AND two (2) years of applicable quality improvement experience, involvement on problem-solving teams, management of data, and use of CQI tools and techniques.

     ADDITIONAL REQUIREMENTS:

    • Ability to work independently and with a very small group of colleagues
    • Ability to use Health Connect/EPIC and Care Everywhere efficiently
    • Manage time efficiently
    • Be self-disciplined

    REQUIRED LICENSURE. CERTIFICATION, REGISTRATION (LCR):

    • Licensure as a registered nurse in Oregon and Washington

    At Northwest Permanente, P.C., we are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants without regard to race, color, religion, sex, pregnancy (including childbirth, lactation and related medical conditions), national origin, age, physical and mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military and veteran status, and any other characteristic protected by applicable law. Northwest Permanente, P.C. believes that diversity, inclusion, and equity among our employees is critical to our success and we seek to recruit, develop and retain the most talented people from a diverse candidate pool.

     

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