[Hiring] Utilization Review RN @Providence

Role Description

Utilization Review RN - REMOTE position. This position is Part time and will work 8-hour, Day shifts.

• 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.
• Requires a strong clinical background combined with well-developed knowledge and skills in Utilization Management, medical necessity, and patient status determination.
• Must 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.

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

• Best-in-class benefits designed to support you and your family.
• 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.