Utilization Review RN

Overview

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 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.

Responsibilities

• Perform admission, concurrent and retrospective UR reviews to determine appropriate admission status based on regulatory and reimbursement requirements of payers.

• Develop and maintain efficient UM processes; track, evaluate and report data related to UM activities.

• Participate in process improvement initiatives and collaborate with multiple departments and multidisciplinary staff.

• Maintain current knowledge of payer requirements and accreditation guidelines related to UM.

Required Qualifications

• Bachelor’s Degree in Nursing (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.

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 base pay range is listed; 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 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 and the California Fair Chance Act.

About the Team

Providence Swedish is the largest not-for-profit health care system in the greater Puget Sound area, with eight hospital campuses and a broad network of care locations. We are dedicated to improving the wellbeing of rural and urban communities by expanding access to quality health care for all.

Providence is proud to be an Equal Opportunity Employer. We are committed to a workplace free from discrimination and harassment and to creating equal opportunities for advancement.

For any concerns with this posting related to RCW 49.58.110(1), please click here to access an email link to submit your concern.

Requsition ID: 392045

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

Pay Range: $51.43 - $79.84