Utilization Review Nurse
4 weeks ago
Job Summary:
As a Utilization Review Nurse at Providence, you will play a critical role in ensuring that patients receive the necessary care and services to achieve optimal health outcomes. This position requires a strong clinical background, blended with a well-developed knowledge and skills in Utilization Management, medical necessity, and patient status determination.
Key Responsibilities:
- Provide prospective, retrospective, and concurrent utilization review for St. Mary Medical Center.
- Conduct clinical reviews and 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.
- Utilize excellent negotiation, communication, problem-solving, and decision-making skills to ensure seamless care coordination.
Requirements:
- Associate's Degree in Nursing.
- California Registered Nurse License.
- 1 year experience working in a remote UR environment or 2 years experience working as an acute hospital case manager.
Preferred Qualifications:
- Bachelor's Degree in Nursing or Master's Degree in Nursing.
- Case Management Certification upon hire.
- Experience working with Interqual guidelines.
- 2 years Experience as a case manager in an acute care setting.
- Experience in a multi-hospital and/or integrated healthcare system.
About Providence:
Providence is a not-for-profit network of hospitals and health services that provides a full spectrum of care with leading-edge diagnostics and treatment. Our award-winning medical centers are known for outstanding programs in cancer, cardiology, neurosciences, orthopedics, women's services, emergency and trauma care, pediatrics, and neonatal intensive care.
Why Work at Providence:
We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities. Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security.
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