Utilization Review (RN) - Per Diem at Kittitas Valley Healthcare

Ellensburg, Washington, United States -

Full Time

Start Date

Immediate

Expiry Date

07 May, 26

Salary

79.6

Posted On

06 Feb, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Utilization Review, Registered Nurse (RN), MCG Criteria, CMS Regulations, Payer Requirements, Pre-authorizations, Medical Necessity, Case Management, Revenue Cycle, Denial Investigation, Length of Stay Monitoring, Utilization Review Committee, Acute Care Experience, Evidence-Based Care Guidelines, Cerner EHR

Industry

Hospitals and Health Care

Description

Company Description 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 Job Description The Utilization Review (UR) RN evaluates the medical necessity, appropriateness, and efficiency of healthcare services using MCG criteria, ensuring compliance with CMS regulations and payer requirements. This role facilitates timely insurance pre-authorizations, confirms medical necessity, and helps prevent avoidable denials. The UR RN works closely with clinical teams, case management, and payers to support safe, efficient care transitions and optimize reimbursement. The UR RN also collaborates with the Revenue Cycle Director and finance teams to investigate denials, inappropriate admission order status, avoidable revenue loss, and other financial risks. Responsibilities include monitoring length of stay and avoidable days, and reporting trends and findings to the Utilization Review Committee to support regulatory compliance and continuous improvement in utilization practices. Qualifications What is required... 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 What is preferred... Bachelor of Science in Nursing (BSN) Experience working with Cerner EHR Knowledge of care guidelines from MCG Hospital case management experience Additional Information Wage: 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. This position may also qualify for an additional 15% premium in lieu of benefits. FTE: Per Diem Benefits: This position is not benefits eligible Union Status: This is a WSNA union covered position Compensation: USD44.70 - USD79.60 - hourly

Responsibilities

The Utilization Review RN evaluates the necessity and efficiency of healthcare services using MCG criteria, ensuring compliance with CMS regulations and facilitating timely insurance pre-authorizations to prevent denials. This role involves close collaboration with clinical teams, case management, and finance to support efficient care transitions, optimize reimbursement, and investigate financial risks like avoidable revenue loss.