Manager, Utilization Management RN *FT/Days*

The Manager of Utilization Management provides a key role in leading, facilitating and managing the hospital utilization management program in the Southern California Region.

The Manager assists the Regional Director of Utilization Management, Appeals & Clinical Training through the provision of ongoing assessment and evaluation of hospital activities related to patient admission, transfers, and discharges in a variety of clinical settings. Accomplishes results through multiple experienced individual staff members who exercise latitude and independence in their assignments. Fosters team collaboration, sharing of workload and enhanced productivity.

This role provides direction for and leadership to a large team of Utilization Management RNs in the care of patients by facilitating allocation of resources related to a pre-determined set of criteria. This role acts as a facilitator between the UM RNs and the ministry Care Management departments. Ensures that there is regulatory compliance for appropriate services that are monitored in order to optimize patient outcomes and maximize optimum financial outcomes. In turn, advocates for full and adequate resource allocation, which is beneficial to the organization where patients receive care.

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.

Required Qualifications:  

• Bachelor's Degree in Nursing or other related area
• Upon hire: California Registered Nurse License
• 5 years Healthcare management experience related to acute care utilization management or appeals management.

Preferred Qualifications:

• Master's Degree in Nursing or other related area
• Coursework/Training: Case Management Certification
• 2 years minimum of two years direct patient care experience in an acute care setting is preferred. Other direct patient care experience may consider in lieu of acute care
• Previous experience working with denials and appeals in/for an acute care setting
• Previous experience working with a remote UR team
• Previous experience as a case manager in an acute care setting

Why Join Providence? 

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 caring for everyone, especially the most vulnerable in our communities.

At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

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. Learn more at providence.jobs/benefits.