Utilization Review Clinical Nurse Specialist

6 days ago


Mission Hills, Kansas, United States Providence Full time
Job Summary

We 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 Role

In this position, you will be part of a comprehensive health care organization serving more people, advancing best practices, and continuing our over 100-year tradition of serving the poor and vulnerable.

Key Responsibilities
  • Conduct thorough reviews of patient records to ensure accurate and timely documentation
  • Develop and implement effective care plans that meet individual patient needs
  • Collaborate with interdisciplinary teams to coordinate care and improve patient outcomes
  • Analyze data to identify trends and opportunities for process improvement
Requirements

To be successful in this role, you will need:

  • 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
Benefits

We offer a comprehensive benefits package, including:

  • A competitive salary range of $52.46 - $83.05 per hour
  • Healthcare benefits (medical, dental, vision)
  • Life insurance
  • Disability insurance
  • Time off benefits (paid parental leave, vacations, holidays, health issues)
  • Voluntary benefits
  • Well-being resources
About Providence

Providence is proud to be an Equal Opportunity Employer, committed to creating a diverse and inclusive workplace. We believe diversity makes us stronger, so we're dedicated to shaping an inclusive workforce where everyone feels valued and respected.



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