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Utilization Review RN

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Providence

Feb 6

Applications are closed

  • Job
    Full-time
    Mid Level
  • Healthcare
  • Seattle

Requirements

  • Required Qualifications
  • Bachelor's Degree in Nursing degree (BSN) from an accredited school of nursing.
  • Upon hire: Washington Registered Nurse License.
  • 3 years Registered nursing experience in the clinical setting.
  • Preferred Qualifications
  • Upon hire: ACM or CCM certification.
  • 1 year Case management experience.

Responsibilities

  • Collaborates and consults with appropriate departments and providers as needed to determine that medical necessity indicators are met.
  • Provides a clinical review of the medical record to determine an admission status type of a patient.
  • Conducts concurrent clinical reviews to assess ongoing medical necessity.
  • Identifies, reports cases and problems appropriate for secondary review to Case Management leadership, the Medical Director or Physician Advisor.
  • Facilitates appropriate provider documentation to accurately reflect patient severity of illness and risk.
  • Maintains collaborative relationships with providers, case management staff, clinics, Revenue Cycle team, and Payer Compliance team.
  • Responsible for submitting clinicals, entering authorizations of both concurrent and hospital stays after discharge. Conducts appeals as applicable.
  • Collaborates with providers, compliance, contracting, revenue cycle, internal and external Physician Advisors. In addition, works with other departments as needed for medical necessity matters.
  • Works in accordance with applicable state and federal laws as well as with the unique requirements of reimbursement systems.
  • Facilitates accurate, compliant clinical documentation by providing concurrent support to providers to optimize reimbursement.
  • Stays current in UR to be informed of reimbursement modalities, resources as well as clinical and legal issues that affect patients and providers of care.
  • Provides leadership with needed workflow reports to analyze productivity, quality concerns, utilization patterns, and denial patterns/trends.
  • Participates in the development, implementation, evaluation, and ongoing revision of initiatives to improve quality, continuity, and cost-effectiveness.
  • Provides clear and thorough documentation based on established department standards.
  • Coordinates education and training for staff and other health care providers regarding utilization management process, including but not limited to: reimbursement patterns, trends, changes in regulations, and strategies.
  • Provides orientation and mentoring to new staff.
  • Escalates issues to Case Management team or leadership in a timely manner.
  • Must demonstrate competency to safely and/or accurately operate the following equipment:
  • PC: Data entry, Windows, Microsoft Word, Excel, PowerPoint, Internet Explorer; E-mail; EPIC and other Case Management software, etc.
  • General Office Equipment: telephones, voice-mail, fax machines, scanners, printers, etc.

FAQs

What is the job title for this position?

The job title is Utilization Review RN.

What are the working hours for this role?

The position is per diem with remote day shift hours.

What qualifications are required for this job?

A Bachelor's Degree in Nursing (BSN) from an accredited school of nursing and a Washington Registered Nurse License upon hire are required, along with 3 years of registered nursing experience in a clinical setting.

Is case management experience preferred?

Yes, 1 year of case management experience is preferred.

Are there any certifications that are required or preferred?

Upon hire, ACM or CCM certification is preferred.

What does the Utilization Review RN do?

The Utilization Review RN performs admission, concurrent, and retrospective utilization reviews to determine appropriate admission status, ensures medical necessity, collaborates with providers, and participates in process improvement initiatives.

Will I have the opportunity to provide training to others?

Yes, the role includes coordinating education and training for staff and other health care providers regarding utilization management processes.

How does this role fit into the larger organization?

The Utilization Review RN is part of the Swedish Shared Services, which is dedicated to patient-focused care and improving the health and wellbeing of communities.

What is the pay range for this position?

The pay range for this role is $51.43 - $79.84, with potential for additional compensation such as shift differentials or bonuses.

Are there benefits associated with this job?

Yes, Providence offers a comprehensive benefits package including health care benefits, retirement savings plans, and time-off benefits.

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Providence

Science & Healthcare
Industry
10,001+
Employees
1856
Founded Year

Mission & Purpose

Every day, 119,000 compassionate caregivers serve patients and communities through Providence St. Joseph Health, a national, Catholic, not-for-profit health system, driven by a belief that health is a human right. Rooted in the founding missions of the Sisters of Providence and the Sisters of St. Joseph of Orange, courageous women ahead of their time who brought health care and other social services to the American West when it was still a rugged, untamed frontier, we share a singular commitment to improve the health of all. From our earliest days, we’ve met new challenges by pioneering new solutions. Today, with 51 hospitals, 829 clinics and a comprehensive range of services, we strive to meet the needs of communities across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington through a diverse family of Catholic, other faith-based and mission-driven secular organizations. Now, as we face a new frontier—a changing health care landscape—we draw upon their pioneering and compassionate spirit to plan for the next century of health for a better world, especially for the poor and vulnerable.

Culture & Values

  • Compassion

    We reach out to those in need and offer comfort as Jesus did. We nurture the spiritual, emotional and physical well-being of one another and those we serve. Through our healing presence, we accompany those who suffer.

  • Dignity

    We value, encourage and celebrate the gifts in one another. We respect the inherent dignity and worth of every individual. We recognize each interaction as a sacred encounter.

  • Justice

    We foster a culture that promotes unity and reconciliation. We strive to care wisely for our people, our resources and our earth. We stand in solidarity with the most vulnerable, working to remove the causes of oppression and promoting justice for all.

  • Excellence

    We set the highest standards for ourselves and our ministries. Through transformation and innovation, we strive to improve the health and quality of life in our communities. We commit to compassionate, safe and reliable practices for the care of all.

  • Integrity

    We hold ourselves accountable to do the right things for the right reasons. We speak the truth with courage and respect. We pursue authenticity with humility and simplicity.

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