Utilization Review RN

at  Providence

DESCRIPTION

Provide prospective, retrospective, and concurrent utilization reviews for our LA ministries. Conduct clinical reviews and review medical records daily during admission for all payers, as required by the health plans. This role requires a strong clinical background combined with well-developed knowledge and skills in Utilization Management, medical necessity, and patient status determination. The Utilization Management RN must effectively and efficiently manage a diverse workload in a fast-paced, rapidly changing regulatory environment, demonstrating excellent negotiation, communication, problem-solving, and decision-making skills.
Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence California Regional Services and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.

REQUIRED QUALIFICATIONS:

• Associate’s Degree in Nursing.
• California Registered Nurse License upon hire.
• 2 years of experience working in a remote UR environment or working as an acute hospital case manager.

PREFERRED QUALIFICATIONS:

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

Please refer the Job description for details