Utilization Review RN - Case Management

Description 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 and criteria related to UM. Required Qualifications Bachelor's Degree in Nursing (BSN) from an accredited school of nursing. Washington Registered Nurse License upon hire. Three years of registered nursing experience in a clinical setting. Preferred Qualifications ACM or CCM certification upon hire. One year of case‑management experience. Benefits 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 more. Additional compensation may be available for this role, including shift differentials, standby/on‑call, overtime, premiums, extra shift incentives or bonus opportunities. The base pay range for this position is $52.26 – $81.13. Equal Opportunity Employer Providence is an Equal Opportunity Employer. We are committed to ensuring every workforce member has a work environment free from unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran status, religion, age, creed, national origin, sexual identity or expression, marital status, genetic information or any other basis prohibited by applicable law. We believe diversity strengthens us and we are dedicated to fostering an inclusive workforce. Additional Information Requisition ID: 438062 Company: Swedish Jobs Job Category: Health Information Management Job Function: Revenue Cycle Job Schedule: Per‑Diem Job Shift: Day Career Track: Nursing Department: 3900 SS CASE MANAGEMENT Address: WA Seattle 1730 Minor Ave Work Location: Swedish Metropolitan Park East‑Seattle Workplace Type: On‑site #J-18808-Ljbffr Providence Swedish Medical Center