RN - Utilization Review

RN - Utilization Review at Providence Health and Services summary :

The Utilization Review Nurse combines clinical nursing expertise with utilization management skills to determine appropriate patient admission status based on regulatory and payer requirements. This role supports the utilization management program at Providence St. Peter Hospital by ensuring compliance with medical necessity and reimbursement guidelines. Candidates must have a Washington RN license and relevant nursing experience, preferably with utilization review, care management, or discharge planning background.

Description

The Utilization Review (UR) Nurse has a strong clinical background blended with 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.

Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence St. Peter Hospital 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 :

• Upon hire : Washington Registered Nurse License
• 3 years of Nursing

Preferred Qualification :

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."

About the Team

Providence has been serving the Pacific Northwest since 1856 when Mother Joseph and four other Sisters of Providence arrived in Vancouver, Washington Territory. Today, Providence is the largest health care provider in Washington located in communities large and small across the state. In western Washington, Providence provides care throughout the greater Puget Sound from Snohomish County to Lewis County.

Our award-winning and comprehensive medical centers are known for outstanding programs in cancer, cardiology, neurosciences, orthopedics, women's services, emergency and trauma care, pediatrics and neonatal intensive care. Our not-for-profit network also provides a full spectrum of care with leading-edge diagnostics and treatment, outpatient health centers, physician groups and clinics, numerous outreach programs, and hospice and home care.

Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.

For any concerns with this posting relating to the posting requirements in RCW 49.58.110(1), please click here where you can access an email link to submit your concern.

Requsition ID : 397848

Company : Providence Jobs

Job Category : Health Information Management

Job Function : Revenue Cycle

Job Schedule : Full time

Job Shift : Day

Career Track : Nursing

Department : 3030 UTILIZATION REVIEW WA PSPH OLYMPIA MAIN 2ND FLOOR QUALITY OFFICES

Address : WA Olympia 413 Lilly Rd NE

Work Location : Providence St Peter Hospital-Olympia

Workplace Type : On-site

Pay Range : $46.30 - $91.32

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.

PandoLogic. Category : Healthcare, Keywords : Utilization Review Nurse, Location : Olympia, WA-98507

Keywords :

Utilization Review Nurse, Utilization Management, Registered Nurse, Medical Necessity, Patient Status Determination, Care Management, Discharge Planning, Healthcare Compliance, Nursing, Revenue Cycle