RN - Utilization Review
About the role
The Utilization Review (UR) Nurse supports the Utilization Management (UM) program by developing and maintaining effective, efficient processes for determining the appropriate admission status based on regulatory and reimbursement requirements of commercial and government payers. This individual utilizes appropriate criteria and interprets the implications of clinical status and the medical treatment plan with current federal regulations/guidelines to expedite the billing process, payment, and prevent governmental sanctions.
Responsibilities
- Performs comprehensive admission, concurrent and retrospective UR related reviews.
- Ensures appropriate data is tracked, evaluated, and reported.
- Participates in process improvement initiatives, collaborating with multiple departments and multidisciplinary staff.
- Keeps up-to-date knowledge regarding commercial and government payers as well as accreditation regulations/guidelines/criteria related to UM.
Requirements
Washington Registered Nurse License. 3 years Nursing experience.
Qualifications
- Bachelor's Degree in Nursing or Associate's Degree in Nursing.
- 3 years' experience in Utilization Review, Care Management, Quality Management, and/or Discharge planning.
Skills
Strong clinical background blended with well-developed knowledge and skills in Utilization Management (UM), medical necessity and patient status determination.
Benefits
Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more.
Pay
$47.69 - $94.06
Schedule
Full time
Shift
Evening