The Nurse Manager provides clinical leadership and oversight to uphold clinical review excellence and competency of staff in the provision of nursing clinical review in support of front-line physicians through implementation of the professional practice model and evidence-based standards. Accountable for coordinating RN clinical review functions including the implementation of regionally consistent practices, processes, and protocols within a clinical review department to achieve excellence in quality of care, customer service, resource utilization, and employee satisfaction. Works closely with the Medical Director in fulfilling the job accountabilities. Perform FMLA clinical review and review of other disability related requests for medical appropriateness to the extent necessary to maintain clinical expertise and competency to fulfill job responsibilities and to direct the provision of clinical review processes within the department and in accordance with licensure and regulatory requirements. This may include doing clinical reviews to cover influxes in the SMART case review pool queue as necessary to meet demand and maintain SMART turnaround times.Under the direction of the Medical Director, serves as a clinical resource to Northwest Permanente (NWP) physicians for disability related form completion requirements and certifications (e.g., FMLA/OFLA/ADAAA, etc); assists the medical director as liaison and subject matter expert in support of regional and inter regional RN clinical review team(s).Serves as patient communication liaison when necessary as it relates to all aspects of the Medical Ability Resource Program, including Leaves of Absence: FMLA (Family Medical Leave Act), OFLA (Oregon Family 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 members 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.This is a hybrid position that is a blend of working both remotely and in office. Must reside in the Northwest Service Region (Oregon or Washington).Major Responsibilities / Essential FunctionsSupervision of SMART Team:
Collaborates with the leadership team and brings the professional nursing clinical perspective to improve the quality of review processes related to the determination of medically appropriate time away from work
Ensures coordinator support staff working to full scope and/or certification. Collaborates with the Senior Director of Nursing to identify opportunities to optimize scope of practice and ensure resource stewardship.
Ensures staff have the required knowledge and skill to perform assignment; provide on-going clinical review skills development; develop processes for regional an interregional sharing and implementation of best practices and provide onboarding of new RNs regionally and inter regionally
Monitors outcome metrics ($$/time loss savings) via review process for medical appropriateness
Collaborates with leadership team as well as with regional and inter regional counterparts to ensure clinical quality through periodic quality review audits; leads peer review process and identifies and implements remediation process when/if needed
Assess urgency of requests for clinical review for the purposes of determining appropriate prioritization and needed actions to assure urgent forms completion
Performs continuous surveillance of all relevant State regulations and Federal regulations pertaining to disability related leave including Leaves of Absence: FMLA (Family Medical Leave Act), OFLA (Oregon Family Leave Act), WFLA (Washington Family Leave Act) WFCA (Washington Family Care Act), and including other States with shared services, (HI); and the Americans with Disabilities Act Amendment Act (ADAAA)
Operations:
Supervises and coordinates staff activities necessary to provide excellent member focused medical reviews for clinician approval
Acts as liaison between the Medical Director, and other support departments to ensure effective communication of overall clinical review processes, including regional communications that cascade to frontline staff
Selects, coaches, and develops performance management of nursing staff in compliance with requirements of EEO/AA goals and personnel policies of NWP. Ensures that RNs continuously focus on identifying and implementing ways to meet/exceed quality and service targets and implement regional initiatives
Supports the development, implementation, and sustainability of standard workflows for FMLA and other disability related forms completion processes
Monitors and controls expenditures, overtime, and staffing levels
Maintains current information and ensures that clinical activities and training incorporate all applicable NWP policies, local, state, and federal laws and regulations and accreditation standards included inter regional licenses as required to support shared services
Ensures compliance with related Patient Safety, EH&S regulations, training requirements and regional emergency preparedness expectations
Researches and resolves customer complaints
Supports Medical Director in collaborating with physician groups and others in the organization (regionally and inter regionally) as well as with employer groups and other external partners to ensure provision of high quality, patient centered clinical review services.
When staffing not able to meet demand, works alongside staff performing comprehensive reviews
Collaborates with leadership team to ensure adoption through training and implementation of procedures designed to impact quality measures as appropriate, i.e., organizational, and department-specific quality and continuous improvement goals
Prepares assigned team(s) for all KPHC upgrades and enhancements in partnership with the KPHC team
Supports regional and inter regional projects and committees related to process improvement and sharing of best practices
Minimum Education
Bachelor's degree in nursing
Minimum Work Experience
Minimum five (5) years of working in subject matter expert, lead, or supervisory position with a variety of healthcare team members managing through influence and collaboration
Minimum five (5) years of experience providing direct patient care
Additional Requirements
Demonstrated understanding of clinical and operational processes, staff licensure/certification, clinical competency requirements, and scope of practice concepts
Ability to analyze, integrate and use quantitative data informed decisions about quality improvement and collaborating with clinical staff, support staff, and team to achieve expected outcomes
Ability to lead in a culturally diverse environment and promote culturally competent care
Ability to communicate effectively in written and spoken English
Ability to attend to details, prioritize and complete multiple tasks independently in a fast-paced environment and following agreed upon timeline
License in state where assigned required upon hire/transfer, application for license in secondary state required within 2 weeks of hire/transfer and must be obtained within 6 months
Additional licensing in States where shared services are indicated
Preferred Education
Master's degree in nursing, healthcare, business administration, or related field
Specialty certification highly desirable
Preferred Work Experience and Qualifications
Three (3) years of supervisory experience to include but not limited to, hiring, disciplinary actions, training, employee development/ assessment, and wage and hour regulations
Five (5) years health care administration in a variety of settings including ambulatory and hospital care
National certification in related clinical field
Hospital and Ambulatory Care experience
Ability to apply process improvement and project management principles
Ability to performance manage, coach, and develop staff
Ability to understand and utilize data to improve performance
Ability to lead and implement change management and process improvement activities
Ability to establish partnerships with physician group, KP HealthPlan (ROI, Marketing/Sale) and KP inter regional partnerships and peers to create a culture of commitment to patient focused service, excellent support of clinical review practices, innovation, compliance, safety, and integrity
Case management/disability management
Join Our Medical GroupNorthwest Permanente is a self-governed, physician-led, multi-specialty group of 1,500 physicians, surgeons, and clinicians, caring for 630,000 members in Oregon and Southwest Washington. Kaiser Permanente is one of the nation's preeminent health care systems, a benchmark for comprehensive, integrated, value-based, and high-quality care.Equal Opportunity EmployerAt Northwest Permanente, 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 believes that equity, inclusion, and diversity among our employees are critical to our success, and we seek to recruit, develop, and retain the most talented people from a diverse candidate pool.
Physician Opportunities in Oregon & Southwest Washington. For more information, please visit https://northwest.permanente.org/ - Northwest Permanente is the Northwest’s largest physician-led, self-governed multispecialty group. We have opportunities available across the region in Portland, Salem, Oregon, and Longview, Washington. Northwest Permanente physicians practice medicine with a purpose that provides unparalleled opportunities for a meaningful and rewarding career in medicine.
