Utilization Review RN - Full-time - REMOTE

Utilization Review RN - Remote. This position is Full-time and will work 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.

Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence California Regional Services and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.

• Associate's Degreein 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 Degreein Nursing.
• Master's Degreein Nursing.
• Experience working with Interqual guidelines.
• Experience in a multi-hospital and/or integrated healthcare system.

Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Missionof caring for everyone, especially the most vulnerable in our communities.