RN Utilization Review - Part-time - REMOTE
ProvidenceAbout the role
RN Utilization Review - Remote. This position is Part- 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.
Required Qualifications:
- Associate's degree in nursing.
- Upon hire: California Registered Nurse License
- 2 years of experience working in a remote UR environment or working as an acute hospital case manager.
- Bachelor's degree in nursing.
- Master's degree in 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 Mission of caring for everyone, especially the most vulnerable in our communities.
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