Registered Nurse (RN) - OR - Operating Room - $31-42 per hour

Kaiser Permanente is seeking a Registered Nurse (RN) OR - Operating Room for a nursing job in Tukwila, Washington.

• Specialty: OR - Operating Room
• Discipline: RN
• Duration: Ongoing
• 40 hours per week
• Shift: 8 hours, days
• Employment Type: Staff

MONDAY THROUGH FRIDAY, MAY INCLUDE SATURDAYS

Job Summary:

The Review Services Coordinator is a critical role in adjudicating pre-authorization coverage requests for all types of services - medical and DME. The work environment is fast paced and at many times complex. Knowledge of health plan functions is required and include reading and interpreting contracts and coverage and understanding claims payment. This role includes handling a high volume of incoming calls from members and providers, managing multiple requests simultaneously and accurately and easily identifying requests that require a higher level of clinical review. This position must have a strong knowledge of medical terminology, CPT, HCPC and ICD coding as well as strong computer skills. This position requires that all CMS, State and Federal compliance and regulatory requirements be met.

• Adjudicate pre-authorization requests for all services - medical & DME. Determine urgency of request based on information provided. Enter & process selected patient medical information into the Referral Management System (RMS) to produce the authorization.


• Receive and process incoming phone calls from members, providers and internal KFHPW departments.


• Perfom and research complex issues related to authorization denials, delays and claims related issues. Ability to get to the root cause of an issue and provide a accurate, concise explanation to the member, provider and/or internal KFHPW department.


• Other duties as assigned (eWatson, training, JIVA, Ring of Defense)

• Minimum two (2) years of health care experience with emphasis in health insurance including pre-authorizations, benefits/eligibility, and billing.


• Minimum two (2) years of experience with online computer systems and Microsoft Office.


• Minimum one (1) year of phone customer service experience.

• High School Diploma or General Education Development (GED) required.

• N/A

• Medicare and strong communication skills.
• Computer skills in Windows environment, including MS Word and Excel.
• Kaiser Foundation Health Plan of Washington applications.
• Communication and interpersonal skills.
• Working knowledge of Health Plan benefits and policies.
• Basic understanding of Medicare regulations, particularly those pertaining to the provision of Part B services.
• Working with the public with emphasis on problem solving and conflict resolution.

• Kaiser Foundation Health Plan of Washington (KFHPW) work experience.
• Experience with health plan contracts & coverage.
• Health plan claims experience.
• Medical coding experience with ICD-9/10, CPT and HCPCS.
• Some college courses preferred.

Kaiser Permanente Job ID #1331567. Posted job title: Review Services Coordinator - Must Live In Kpwa Market Or Relocate

At the heart of health care, you'll find Kaiser Permanente. As the nations leading not-for-profit, integrated health plan, we make a difference in the lives of members, patients, and communities across the country.

With 39 hospitals and more than 734 locations in eight states and the District of Columbia, we proudly serve more than 12.7 million members from coast to coast. Whether you choose to join a hospital in the Northwest, a clinic in Southern California, or a medical office in the Mid-Atlantic, we have many opportunities for you to shape the future of care.

Our teams are empowered to advance impactful and extraordinary care for all by pioneering health outcomes, encouraging diverse viewpoints, and creating new opportunities for learning and advancement. This covers more than our members and our employees; it also reaches far into our communities. Together, we're proudly working as one for a healthier today and tomorrow.