RN - Utilization Review
Listed on 2026-07-02
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Nursing
Clinical Nurse Specialist, Healthcare Nursing, RN Nurse, Public Health Nurse
The Utilization Review (UR) Nurse has a strong clinical background blended with well-developed knowledge and skills in Utilization Management (UM), medical necessity and patient status determination. This individual supports the UM program by developing and maintaining effective, efficient processes for determining the appropriate admission status based on regulatory and reimbursement requirements of commercial and government payers. Utilizes appropriate criteria and interprets the implications of clinical status and the medical treatment plan with current federal regulations/guidelines thereby expediting the billing process, payment and preventing governmental sanction.
The UR nurse is responsible for performing comprehensive admission, concurrent and retrospective UR related reviews and functions to ensure that appropriate data is tracked, evaluated and reported. This individual actively participates in process improvement initiatives, working with multiple departments and multi-disciplinary staff. This role requires current and accurate knowledge regarding commercial and government payers as well as accreditation regulations/guidelines/criteria related to UM.
- Upon hire:
Washington Registered Nurse License. - 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, and/or Discharge planning.
Providence is proud to be an Equal Opportunity Employer. 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 on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.
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