Clinical Utilization Review Nurse

1 week ago


Everett, Washington, United States Providence Full time

Position Overview:
As a Clinical Utilization Review Nurse, you will be responsible for managing and evaluating the utilization of healthcare services for patients during their hospital stay. This role involves conducting clinical assessments and overseeing denial appeals when necessary, either during the patient's admission or after discharge.

About Providence:
At Providence, we are dedicated to providing exceptional patient-centered care. Our commitment to understanding and respecting each individual's needs fosters a culture of collaboration and support among our caregivers.

Key Responsibilities:
- Supervise utilization management processes and ensure the delivery of quality patient care.
- Conduct thorough clinical reviews and facilitate denial appeals as required.
- Collaborate with healthcare teams to optimize patient outcomes and resource utilization.

Required Qualifications:
- Bachelor’s Degree in Nursing (BSN) is essential. Candidates must obtain a BSN within five years of employment.
- Valid Washington Registered Nurse License upon hire.
- Recent experience as an RN in an acute care environment or relevant utilization management experience within the last five years.

Preferred Qualifications:
- Experience in utilization review or case management.
- Familiarity with Interqual or Milliman Criteria.
- Background in care management, medical insurance, or discharge planning.

Why Choose Providence?
We offer a comprehensive benefits package designed to support your health, professional growth, and financial security. Our inclusive workplace values diversity and ensures that every caregiver is respected and heard.

About Our Team:
Providence has a long-standing tradition of serving communities with compassion and excellence. Our network encompasses a wide range of healthcare services, ensuring that we meet the diverse needs of those we serve.

Compensation:
The salary range for this position is competitive, with additional compensation opportunities available based on various factors.



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