RN - Utilization Review

Job Summary

The Utilization Review (UR) Nurse supports the Utilization Management (UM) program by developing and maintaining processes for determining admission status based on regulatory and reimbursement requirements of commercial and government payers. The UR nurse performs comprehensive admission, concurrent and retrospective UR‑related reviews, tracks, evaluates and reports data, and ensures that appropriate billing is expedited while preventing governmental sanctions. This role actively participates in process improvement initiatives and works with multiple departments and multidisciplinary staff.

• Perform admission, concurrent, and retrospective utilization review assessments.
• Track, evaluate, and report data related to patient status and medical necessity.
• Ensure compliance with federal regulations, guidelines, and payer policies.
• Participate in process improvement initiatives across departments.
• Collaborate with multidisciplinary staff to support accurate medical driving decisions.

• Washington Registered Nurse license upon hire.
• 3 years of nursing experience.

• Bachelor’s Degree in Nursing or associate’s degree in nursing.
• 3 years of experience in utilization review, care management, quality management, or discharge planning.

Pay range: $47.69 - $94.06 per hour. This figure represents the base pay; additional compensation may include shift differentials, standby/on‑call, overtime, bonuses, and other incentives. Providence offers a comprehensive benefits package that includes a 401(k) retirement savings plan with employer matching, medical/dental/vision insurance, life and disability insurance, paid parental leave, vacation and holiday pay, and access to well‑being resources.

• Company:
  Providence St. Peter Hospital
• Location:
  
  Remote, Olympia, WA (work site Providence St Peter Hospital – Olympia)
• Schedule:
  
  Full time, day shift
• Department:
  Utilization Review
• Career Track:
  Nursing

Providence is proud to be an Equal Opportunity Employer. We are committed to providing a workplace free from unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran status, religion, age, creed, national origin, sexual orientation or expression, marital status, genetic information, or any other basis prohibited by local, state, or federal law. Diversity makes us stronger, and we are dedicated to cultivating an inclusive workforce and providing equal opportunities for advancement.