Utilization Review RN at Providence Medical Grp.

Seattle, Washington, United States -

Full Time

Start Date

Immediate

Expiry Date

16 Jan, 26

Salary

0.0

Posted On

18 Oct, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Utilization Management, Medical Necessity, Patient Status Determination, Process Improvement, Accreditation Regulations, Case Management, Registered Nursing, Data Tracking, Evaluation, Reporting

Industry

Hospitals and Health Care

Description

This is a remote role. You MUST live in the state of Washington (WA) to be considered Care Manager RN Per diem / On call Day shift The Utilization Review (UR) Nurse has a strong clinical background blended with a well-developed knowledge and skills in Utilization Management (UM), medical necessity and patient status determination. This individual supports the 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. The UR nurse is responsible for performing admission, concurrent and retrospective UR related reviews and functions to ensure that appropriate data is tracked, evaluated and reported. This individual actively participates in process improvement initiatives, working with multiple departments and multi-disciplinary staff. This role requires current and accurate knowledge regarding commercial and government payers as well as accreditation regulations/guidelines/criteria related to UM. Providence caregivers are not simply valued – they’re invaluable. Join our team at Swedish Shared 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: Bachelor's Degree in Nursing degree (BSN) from an accredited school of nursing. Washington Registered Nurse License upon hire. 3 years of Registered nursing experience in the clinical setting. Preferred Qualifications: ACM or CCM certification upon hire. 1 year of Case management experience. Why Join Providence? Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our mission of improving the health and wellbeing of each patient we serve.

Responsibilities

The Utilization Review Nurse supports the UM program by developing and maintaining processes for determining appropriate admission status. They perform admission, concurrent, and retrospective UR reviews to ensure data is tracked and reported effectively.