Utilization Review RN
2 days ago
Job DescriptionResponsible for providing utilization review and coordination of care throughout the healthcare continuum to promote quality and cost effective care to the members.Providence caregivers are not simply valued - they're invaluable. Join our team at Providence Medical Foundation 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.Required qualifications: Nursing school graduate. California Registered Nurse License upon hire 3 years of experience in utilization management and/or case management. 3 years of clinical experience in hospital or medical office/clinic setting. Experience with Milliman criteria.Preferred qualifications: Bachelor's Degree in Nursing or related field. Certification in Case Management (CCM) upon hireWhy 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 caring for everyone, especially the most vulnerable in our communities.About UsAt 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 amounts listed are the base pay range; 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 much more. Learn more at providence.jobs/benefits.About the TeamProvidence Clinical Network (PCN) is a service line within Providence serving patients across seven states with quality, compassionate, coordinated care. Collectively, our medical groups and affiliate practices are the third largest group in the country with over 11,000 providers, 900 clinics and 30,000 caregivers. PCN is comprised of Providence Medical Group in Alaska, Washington, Montana and Oregon; Swedish Medical Group in Washington's greater Puget Sound area, Pacific Medical Centers in western Washington; Kadlec in southeast Washington; Providence's St. John's Medical Foundation in Southern California; Providence Medical Institute in Southern California; Providence Facey Medical Foundation in Southern California; Providence Medical Foundation in Northern and Southern California; and Covenant Medical Group and Covenant Health Partners in west Texas and eastern New Mexico.Providence is proud to be an Equal Opportunity Employer. We are committed to the principle 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, 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.
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Utilization Review RN
2 weeks ago
Mission Hills, United States Providence Full timeDescription Responsible for providing utilization review and coordination of care throughout the healthcare continuum to promote quality and cost effective care to the members. Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence Medical Foundation and thrive in our culture of patient-focused, whole-person care...
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Utilization Review RN
2 weeks ago
Mission Hills, United States Providence Full timeDescription Responsible for providing utilization review and coordination of care throughout the healthcare continuum to promote quality and cost effective care to the members. Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence Medical Foundation and thrive in our culture of patient-focused,...
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Utilization Review Clinical Nurse Specialist
1 week ago
Mission Hills, Kansas, United States Providence Full timeJob SummaryWe are seeking a skilled Utilization Review RN to join our team at Providence Medical Foundation. This role is responsible for providing utilization review and coordination of care throughout the healthcare continuum to promote quality and cost-effective care to our members.About the RoleIn this position, you will be part of a comprehensive health...
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Utilization Review RN
2 weeks ago
Mission Hills, United States Providence Health & Service Full timeDescription Responsible for providing utilization review and coordination of care throughout the healthcare continuum to promote quality and cost effective care to the members. Providence caregivers are not simply valued - they're invaluable. Join our team at Providence Medical Foundation and thrive in our culture of patient-focused, whole-person care built...
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Utilization Review RN
2 weeks ago
Mission Hills, United States Providence Service Full timeDescription Responsible for providing utilization review and coordination of care throughout the healthcare continuum to promote quality and cost effective care to the members. Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence Medical Foundation and thrive in our culture of patient-focused, whole-person care...
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Utilization Review Clinical Specialist
1 week ago
Mission Hills, United States Providence Full timeAbout the Role:">We are seeking a highly skilled and experienced Utilization Review Nurse to join our team at Providence Medical Foundation. As a key member of our clinical network, you will play a critical role in promoting quality and cost-effective care for our patients.Key Responsibilities:">Provide utilization review and coordination of care throughout...
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Utilization Review RN
2 weeks ago
Nichols Hills, United States Norman Regional Health System Full timeOverview: The Utilization Review team is comprised of highly skilled Registered Nurses who ensure Norman Regional Health System follows a compliant review process to determine appropriateness of admission. Responsibilities: Utilization Review, Utilization Management, Advocacy and Education Clinical Analysis and Data Management Clinical Care...
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Utilization Review RN Part-time/Days
2 weeks ago
Mission Hills, United States Providence Full timeDescription Provide prospective, retrospective, and concurrent utilization reviews for our LA 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,...
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Utilization Review RN Per Diem/Days
1 month ago
Mission Hills, United States Providence Full timeDescription Provide prospective, retrospective, and concurrent utilization reviews for our LA 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,...
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Utilization Review Nurse
1 week ago
Mission Hills, United States Providence Service Full timeJob OverviewWe are seeking a skilled Utilization Review Nurse to join our team at Providence Service. As a Utilization Review Nurse, you will play a crucial role in promoting quality and cost-effective care for our members.About the RoleThis is a full-time position, working day shifts. The salary for this role is $52.46 - $83.05 per hour, with additional...
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Utilization Review RN
2 weeks ago
Mission Hills, CA, United States Providence Full timeDescription Responsible for providing utilization review and coordination of care throughout the healthcare continuum to promote quality and cost effective care to the members. Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence Medical Foundation and thrive in our culture of patient-focused,...
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Utilization Review RN
2 weeks ago
Mission Hills, CA, United States Providence Full timeDescription Responsible for providing utilization review and coordination of care throughout the healthcare continuum to promote quality and cost effective care to the members. Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence Medical Foundation and thrive in our culture of patient-focused,...
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Utilization Review RN
6 days ago
Mission Hills, CA, United States Providence Full timeDescription Responsible for providing utilization review and coordination of care throughout the healthcare continuum to promote quality and cost effective care to the members. Providence caregivers are not simply valued - they're invaluable. Join our team at Providence Medical Foundation and thrive in our culture of patient-focused,...
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Manager, Utilization Management RN FT/Days
1 month ago
Mission Hills, United States Providence Full timeDescription The Manager of Utilization Management provides a key role in leading, facilitating and managing the hospital utilization management program in the Southern California Region. The Manager assists the Regional Director of Utilization Management, Appeals & Clinical Training through the provision of ongoing assessment and evaluation of hospital...
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Manager, Utilization Management RN *FT/Days*
1 month ago
Mission Hills, United States Providence Careers Full timeDescription The Manager of Utilization Management provides a key role in leading, facilitating and managing the hospital utilization management program in the Southern California Region. The Manager assists the Regional Director of Utilization Management, Appeals & Clinical Training through the provision of ongoing assessment and evaluation...
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Care Manager
6 days ago
Beverly Hills, California, United States Mass General Brigham Full timeAbout the RoleMass General Brigham seeks a skilled Care Manager to join their experienced Case Management team in Beverly, Massachusetts. This role focuses on transition planning and utilization review, ensuring seamless care delivery for patients.In this position, you will work closely with multidisciplinary teams to assess patient needs, develop...
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Registered Nurse
3 weeks ago
Mission Hills, United States Incredible Health Full timeHospitals on Incredible Health are actively hiring and accepting applications in the Mission Hills, CA area for the following position: Registered Nurse - Utilization Management Manager. Nurses with experience in any of the following areas are strongly encouraged to apply: Assistant Nurse Manager, CNO, Charge, Clinical Nurse Coordinator, Clinical pathway,...
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Registered Nurse
3 weeks ago
Mission Hills, United States Incredible Health Full timeHospitals on Incredible Health are actively hiring and accepting applications in the Mission Hills, CA area for the following position: Registered Nurse - Utilization Management Manager. Nurses with experience in any of the following areas are strongly encouraged to apply: Assistant Nurse Manager, CNO, Charge, Clinical Nurse Coordinator, Clinical pathway,...
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Clinical Utilization Management Nurse
1 week ago
Mission Hills, United States Providence Full timeAbout ProvidenceAt Providence, we are a comprehensive health care organization with a rich history of serving the poor and vulnerable. Our strength lies in our promise of Know me, care for me, ease my way. We provide whole-person care built on understanding, commitment, and mutual respect, empowering our caregivers to inspire and retain the best people.Job...
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LVN / LPN/Utilization Review
1 month ago
Beverly Hills, United States Diverse Lynx Full time*** This position will travel to multiple clinics for incident management and staff training *** This position will be supervised and receive assignments from a remote RN Mileage reimbursement provided Schedule: Monday-Friday Shift: 0800-1700 Required: * 2+ Years of Ambulatory Care experience * CA LVN license * Driver's License and...
