Utilization Review RN - Full-time - REMOTE

About the role

This position is Full-time and will work 8-hour, Day shifts. Provide prospective, retrospective, and concurrent utilization reviews for our Southern CA ministries. Conduct clinical reviews and review medical records daily during admission for all payers, as required by the health plans.

Responsibilities

• Provide prospective, retrospective, and concurrent utilization reviews for our Southern CA ministries.
• Conduct clinical reviews and review medical records daily during admission for all payers, as required by the health plans.
• Manage a diverse workload in a fast-paced, rapidly changing regulatory environment.
• Demonstrate excellent negotiation, communication, problem-solving, and decision-making skills.

Requirements

• Aceess Associate's Degree in Nursing.
• Candidate must be California Registered Nurse License.
• Two (2) years' experience working in a remote UR environment or working as an acute hospital case manager.

Qualifications

• Bachelor's Degree in Nursing preferred.
• Master's Degree in Nursing preferred.
• Experience working with Interqual guidelines preferred.
• Experience in a multi-hospital and/or integrated healthcare system preferred.

Skills

Strong clinical background combined with well-developed knowledge and skills in Utilization Management, medical necessity, and patient status determination.

Benefits

Your voice matters here, because we know that to inspire and retain the best people, we must empower them. 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

The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Schedule

Full time. Works 8-hour, Day shifts.

Work Location

Remote