Utilization Review RN - Remote

Responsibilities

The RN Care Coord-Qual Med Mgmt will provide administration of medical management programs that include: prior authorization, concurrent hospital and skilled nursing review, appeals and grievance, delegation, medical policy development and medical claims audits. These programs are developed to manage medical expense, determine medically appropriate services and define clinical criteria for decision making. This includes retrospective review of claims and other data, as well as care coordination and discharge planning.

• Oregon
• Washington

• 5 years Clinical nursing experience.
• Upon hire:
  Oregon Registered Nurse License and Washington State Registered Nurse License
• Experience working with physicians in collaboration and management of patient care.

• Bachelor's Degree Nursing or health care.
• Utilization review, discharge planning and/or managed care experience.
• Psychiatric Mental Health Nurse Certification PMH-BC

• Oregon:
  Non-Portland Service Area – Min: $45.90, Max: $71.40
• Oregon:
  Portland Service Area – Min: $49.34, Max: $76.59
• Washington:
  Western – Min: $51.43, Max: $79.84
• Washington:
  Southwest - Olympia, Centralia & Below – Min: $49.34, Max: $76.59
• Washington:
  Eastern – Min: $43.90, Max: $68.16
• Washington:
  South Eastern – Min: $45.90, Max: $71.40

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 much more.

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.

Applicants in the Unincorporated County of Los Angeles:
Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.