RN Utilization Review Full-time Day

Job Description

Description

RN Utilization Review at Providence Holy Cross Medical Center in Mission Hills, CA. This position is Full- time and will work 8-hour, Day shifts.

Providence Holy Cross Medical Center is four-time designated for Magnet® status, the highest recognition for nursing excellence, making it one of just four hospitals in California to achieve this status.

Since 2007, Holy Cross has been recognized as a Magnet® hospital—a prestigious designation from the American Nurses Credentialing Center (ANCC), which recognizes organizations that provide the highest-quality care. Only 9.96% of U.S. hospitals earn Magnet® recognition, which means that only 1% of U.S. hospitals are four times designated.

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 Nursing.
• Upon hire : California Registered Nurse License.
• 2 years Experience working in a remote UR environment or working as an acute hospital case manager.

Preferred Qualifications :

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 caring for everyone, especially the most vulnerable in our communities.

About Providence

At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

The amounts listed 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.

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. Learn more at providence.jobs / benefits.

Applicants in the Unincorporated County of Los Angeles : Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act."

Requsition ID : 397447

Company : Providence Jobs

Job Category : Health Information Management

Job Function : Revenue Cycle

Job Schedule : Full time

Job Shift : Multiple shifts available

Career Track : Nursing

Department : 7000 UTILIZATION MGMT REMOTE

Address : CA Mission Hills 15031 Rinaldi St

Work Location : Providence Holy Cross Medical Ctr-Mission Hills

Workplace Type : On-site

Pay Range : $56.44 - $87.63

The amounts listed 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.

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