Utilization Review Nurse

4 weeks ago


Apple Valley, Minnesota, United States Providence Service Full time
Job Summary

As a Utilization Review Nurse at Providence, you will play a vital role in ensuring that our patients receive the most appropriate and effective care. Your clinical expertise and knowledge of utilization management principles will enable you to make informed decisions about patient care and drive positive outcomes.

Key Responsibilities

* Conduct thorough clinical reviews of patient records to determine medical necessity and appropriateness of care
* Collaborate with healthcare teams to develop and implement effective care plans
* Utilize Interqual guidelines to inform decision-making and ensure compliance with regulatory requirements
* Communicate with payers and other stakeholders to resolve issues and ensure timely payment

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

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. 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.

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