Utilization Review (RN) - Part Time (28 hours/week)

About the role

KVH is an integrated healthcare delivery system that includes 24-hour emergency care, inpatient, and outpatient hospital services through KVH Hospital. Clinics and services provided include family medicine, internal medicine, a geriatric nurse practitioner program, home health and hospice, physical therapy, orthopedics, general surgery, pediatrics, women’s health, and urgent care. Kittitas Valley Healthcare expects all employees to uphold our Vision & Mission. The KVH Vision, Mission & Guiding Principles can be found at http://www.kvhealthcare.org/mission-and-vision. KVH puts ‘employee care’ high on the priority list, with health benefits like low cost medical, dental, and vision insurance and a robust employee wellness program. KVH offers company contribution toward your choice of medical, dental, and vision insurance coverage, including coverage available for spouses/ domestic partners, and dependent children. KVH believes that continuing education is critical to our mission and vision. We have implemented many educational programs such as the Medical Assistant Apprenticeship program and certification pay to encourage continuing education. We want our employees to know they are valued. One of the ways we show this is by quickly vesting employees, making them pension eligible after just one year of part-time status. To view more details about the comprehensive benefits package we offer to eligible employees visit our website - Benefits - KV Healthcare www.kvhealthcare.org

Responsibilities

• Evaluate medical necessity, appropriateness, and efficiency of healthcare services using MCG criteria, ensuring compliance with CMS regulations and payer requirements.
• Facilitate timely insurance pre-authorizations, confirm medical necessity, and help prevent avoidable denials.
• Work closely with clinical teams, case management, and payers to support safe, efficient care transitions and optimize reimbursement.
• Collaborate with the Revenue Cycle Director and finance teams to investigate denials, inappropriate admission order status, avoidable revenue loss, and other financial risks.
• Monitor length of stay and avoidable days, and report trends and findings to the Utilization Review Committee to support regulatory compliance and continuous improvement in utilization practices.

Requirements

• Graduate of an accredited nursing program with a current Washington State Registered Nurse (RN) license or Multistate License (MSL) with Washington endorsement (maintenance required)
• Minimum of 3 years of clinical nursing experience in acute care
• Experience with evidence-based care guidelines such as InterQual or MCG
• Familiarity with CMS Conditions of Participation, commercial health insurance and managed care billing requirements

Qualifications

• Bachelor of Science in Nursing (BSN)
• Experience working with Cerner EHR
• Knowledge of care guidelines from MCG
• Hospital case management experience

Benefits

This position is benefits eligible. KVH offers health benefits like low cost medical, dental, and vision insurance and a robust employee wellness program, company contribution toward your choice of medical, dental, and vision insurance coverage (including spouses/domestic partners and dependent children), continuing education programs such as the Medical Assistant Apprenticeship program and certification pay, quick vesting making employees pension eligible after one year of part-time status. For more details see the benefits page at www.kvhealthcare.org.

Pay

Wage range currently starts at $44.70/hour and goes up to $79.60/hour. Actual wage will be based on years of applicable experience. Shift differentials apply: Evenings (3p‑11p) = $3.00/hour, Nights (11p‑7a) = 12% of hourly base rate, Weekends = $3.50/hour.

Schedule

FTE: .7 (28 hours/week)

Union Status: This is a WSNA union covered position.