Utilization Review RN - Case Management

Description

The Utilization Review (UR) Nurse has a strong clinical background blended with a 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. The UR nurse is responsible for performing 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 and criteria related to UM.

• Bachelor's Degree in Nursing (BSN) from an accredited school of nursing.
• Washington Registered Nurse License upon hire.
• 3 years of registered nursing experience in the clinical setting.

• ACM or CCM certification upon hire.
• 1 year of case management experience.

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 mission of improving the health and wellbeing of each patient we serve.

Base pay range: $52.26 – $81.13 per hour. Additional compensation may be available for this role, such as shift differentials, standby/on‑call, overtime, premiums, extra shift incentives or bonus opportunities.

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.