[Hiring] RN Utilization Review @Providence

Role 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. This role requires a strong clinical background combined with well-developed knowledge and skills in Utilization Management, medical necessity, and patient status determination. The Utilization Management RN must effectively and efficiently manage a diverse workload in a fast-paced, rapidly changing regulatory environment, demonstrating excellent negotiation, communication, problem-solving, and decision-making skills.

Qualifications

• Associate's Degree Nursing.
• Upon hire: California Registered Nurse License.
• 2 years Experience working in a remote UR environment or working as an acute hospital case manager.

Requirements

• Bachelor's Degree Nursing (Preferred).
• Master's Degree Nursing (Preferred).
• Experience working with Interqual guidelines (Preferred).
• Experience in a multi-hospital and/or integrated healthcare system (Preferred).

Benefits

• Comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching.
• Health care benefits (medical, dental, vision).
• Life insurance and disability insurance.
• Time off benefits (paid parental leave, vacations, holidays, health issues).
• Voluntary benefits and well-being resources.
• Additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Company Description

Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence California Regional Services 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.

• 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 foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected.
• Our 120,000 caregivers 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.