Utilization Review RN - Remote

Description Utilization Review RN - Remote. The RN Care Coord‑Qual Med Mgmt will provide administration of medical management programs that include prior authorization, concurrent hospital and skilled nursing review, appeals and grievance, delegation, medical policy development and medical claims audits. These programs are developed to manage medical expense, determine medically appropriate services and define clinical criteria for decision making. The role includes retrospective review of claims and other data, care coordination and discharge planning. Location 100% remote. Candidates must reside in Oregon or Washington. Required Qualifications 5 years clinical nursing experience. Upon hire, obtain Oregon Registered Nurse License and Washington State Registered Nurse License. Experience working with physicians in collaboration and management of patient care. Preferred Qualifications Bachelor's Degree in Nursing or related health care field. Experience in utilization review, discharge planning, and/or managed care. Psychiatric Mental Health Nurse Certification PMH‑BC. Salary Range by Location Oregon (Non-Portland Service Area): $45.90 – $71.40 per hour. Oregon (Portland Service Area): $49.34 – $76.59 per hour. Washington (Western): $51.43 – $79.84 per hour. Washington (Southwest – Olympia, Centralia & Below): $49.34 – $76.59 per hour. Washington (Eastern): $43.90 – $68.16 per hour. Washington (South Eastern): $45.90 – $71.40 per hour. Benefits Providence offers a comprehensive benefits package that includes a retirement 401(k) savings plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, paid parental leave, vacation, holidays, health issues time off, voluntary benefits, well‑being resources, and more. Equal Opportunity Employer Statement Providence is proud to be an Equal Opportunity Employer. We are committed to ensuring 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 status, 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. #J-18808-Ljbffr