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Utilization Review RN - *Per-diem/Day*

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Providence

26d ago

  • Job
    Full-time
    Junior Level
  • Healthcare

AI generated summary

  • You must have an Associate's Degree in Nursing, a California RN license, and 2 years of experience in remote UR or acute hospital case management. Preferred: Bachelor's or Master's in Nursing.
  • You will conduct prospective, retrospective, and concurrent utilization reviews, manage medical record reviews, and apply clinical knowledge to determine medical necessity and patient status.

Requirements

  • Required Qualifications
  • * 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.
  • Preferred Qualifications
  • * Bachelor's Degree Nursing.
  • * Master's Degree Nursing.
  • * Experience working with Interqual guidelines.
  • * Experience in a multi-hospital and/or integrated healthcare system.

Responsibilities

  • Provide prospective, retrospective, and concurrent utilization reviews for our LA 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.

FAQs

What are the primary responsibilities of the Utilization Review RN?

The primary responsibilities include conducting prospective, retrospective, and concurrent utilization reviews, performing clinical reviews, and reviewing medical records daily during admission for all payers as required by health plans.

What qualifications are required for this position?

An Associate's Degree in Nursing, a California Registered Nurse License upon hire, and 2 years of experience working in a remote UR environment or as an acute hospital case manager are required.

Are there any preferred qualifications for this role?

Yes, preferred qualifications include a Bachelor's Degree in Nursing, a Master's Degree in Nursing, experience working with Interqual guidelines, and experience in a multi-hospital and/or integrated healthcare system.

Is this position part-time or full-time?

This position is per-diem/day.

What kind of work environment can I expect?

You can expect a fast-paced and rapidly changing regulatory environment, where you will manage a diverse workload while demonstrating strong negotiation, communication, problem-solving, and decision-making skills.

What is Providence's commitment to diversity and inclusion?

Providence is committed to creating an inclusive workforce where diversity is valued, and every employee is essential, heard, and respected. We adhere to equal opportunity employment principles.

What benefits does Providence offer?

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

What is the pay range for this position?

The pay range for this position is $56.44 - $87.63, with additional compensation possibilities like shift differentials, standby/on-call, overtime, and bonuses.

Where is this position located?

The position is located at Providence Holy Cross Medical Center in Mission Hills, CA.

Is experience in Utilization Management necessary for this position?

Yes, a strong clinical background and well-developed knowledge and skills in Utilization Management, medical necessity, and patient status determination are essential for this role.

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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.