Utilization Review RN

🕒 4 days ago

🏄 California – Remote

🏄 California – Remote

💵 $5.7k - $8.9k / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

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Providence

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1856

💼 Consulting

🛡️ Insurance

🏥 Healthcare

Consulting • Insurance • Healthcare

Providence is a not-for-profit health system committed to providing a wide range of medical services, including primary care, urgent care, pediatrics, maternity care, cancer treatment, and specialized services like neurosurgery and orthopedics. They offer both in-person and virtual care through clinics and a mobile app, ensuring patients can access healthcare conveniently. With a mission rooted in compassion, dignity, and justice, Providence emphasizes serving those who are vulnerable and strives for excellence in healthcare delivery. They are involved in research and innovation, including genomic profiling and clinical trials to improve patient outcomes.

📋 Description

• Provide prospective, retrospective, and concurrent utilization reviews for our Southern CA ministries. • Conduct clinical reviews and review medical records daily during admission for all payers, as required by the health plans. • Effectively and efficiently manage a diverse workload in a fast-paced, rapidly changing regulatory environment. • Demonstrate excellent negotiation, communication, problem-solving, and decision-making skills.

🎯 Requirements

• Associate's Degree in Nursing. • Upon hire: California Registered Nurse License. • 2 years' experience working in a remote UR environment or working as an acute hospital case manager. • Bachelor's Degree in Nursing (preferred). • Master's Degree in Nursing (preferred). • Experience working with Interqual guidelines (preferred). • Experience in a multi-hospital and/or integrated healthcare system (preferred).

🏖️ Benefits

• retirement 401(k) Savings Plan with employer matching • health care benefits (medical, dental, vision) • life insurance • disability insurance • paid parental leave • vacations • holidays • health issues • voluntary benefits • well-being resources