RN Utilization Review REMOTE

Join to apply for the RN Utilization Review - Full-time Days - REMOTE role at Providence Health & Services
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RN Utilization Review at Irvine, CA. This position is Full-time and will work Remote 8‑hour, Day shifts.
Provide prospective, retrospective, and concurrent utilization reviews for our Southern CA ministries. Conduct clinical reviews and review medical records daily during admission for all payers, as required by the health plans. This role requires a strong clinical background combined with well‑developed knowledge and skills in Utilization Management, medical necessity, and patient status determination.
The Utilization Management RN must effectively and efficiently manage a diverse workload in a fast‑paced, rapidly changing regulatory environment, demonstrating excellent negotiation, communication, problem solving, and decision‑making skills.

• Associate's Degree Nursing.
• Upon hire:
  California Registered Nurse License.
• 2 years experience working in a remote UR environment or working as an acute hospital case manager.

• Bachelor's Degree Nursing.
• Master's Degree Nursing.
• Experience working with Interqual guidelines.
• Experience in a multi‑hospital and/or integrated healthcare system.

Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well‑being resources, and more.

Location:

Remote (Irvine, CA). Pay range: $56.44 - $87.63 per hour, with potential shift differentials, standby/on‑call, overtime, premiums, extra shift incentives, or bonus opportunities.