9 days old

Coverage Decision Support Unit Clinical Specialist, Oakland, Temp

Kaiser Permanente
Oakland, CA 94612

Performs day to day utilization management activities in the Coverage Decision Support Unit (CDSU) related to and including consultation, case review, and notification of members regarding UM coverage decisions.

Essential Responsibilities:
  • Provides clinical and regulatory expertise in the review of denial supporting documentation and member / physician notification. Provides high quality, timely consultation to physicians, managers, and staff regarding requirements related to medical necessity and benefit denials across the continuum of care. Consults on the correct and consistent application, interpretation, and utilization of member healthcare benefits.
  • Participates in the development and delivery of education and training programs for staff and physicians at the local and regional level.
  • Performs data analysis and develops reports to identify opportunities for improvement. Assists in the determination of goals and priorities for the CDSU team. Supports appropriateauditing activities, and participates in the evaluation of action plan effectiveness.   
  • Participates in the development, implementation and maintenance of unit policies and procedures. Maintains knowledge and expertise on UM decision-making guidelines/criteria and participates in annual inter-rater reliability assessments.
  • Attends meetings, participates on committees and multi-disciplinary project teams, and works on other UM issues, systems, or processes as assigned by the manager.
  • Kaiser Permanente conducts compensation reviews of positions on a routine basis.  At any time, Kaiser Permanente reserves the right to reevaluate and change job descriptions, or to change such positions from salaried to hourly pay status.  Such changes are generally implemented only after notice is given to affected employees.Add Text Here
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    Posted: 2019-12-04 Expires: 2020-01-03

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    Coverage Decision Support Unit Clinical Specialist, Oakland, Temp

    Kaiser Permanente
    Oakland, CA 94612

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