Manager Utilization Management RN, Prior Authorization *Remote*

Providence Health Plan caregivers are not simply valued – they’re invaluable. Join our team 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. 

 

Providence Health Plan is calling a Manager Utilization Management RN, Prior Authorization who will:

• Be responsible for Management and supervision of the PHP Utilization Management (UM) or Care Management (CM) clinical programs, outcomes and operations
• Be responsible for collaboration and coordination of all UM or CM programs with key Oregon and System leadership throughout Providence St. Joseph's Health
• Coordinate, manage, and direct clinical programs and department operations
• Develop, analyze and provide consultation on UM or CM outcomes
• Have direct reports that include supervisors, program managers, registered nurses, social workers, clinical support coordinators, technicians and may include other support staff as needed
• Foster, develop and maintain key working relationships throughout The Plan, all regions and ministries in Providence St. Joseph's Health with a common goal of providing high quality, affordable programs and services to all members and providers in all areas where Providence serves out the Mission

Providence welcomes 100% remote work for residents who reside in the following States: 

• Washington
• Oregon

Required qualifications for this position include:

• Bachelor's Degree in Nursing or another clinical field of study
  • Graduate from an accredited school of nursing -OR- a combination of equivalent education and work experience
• Coursework/Training: Formal education or training in supervision, management, or leadership
• Oregon Registered Nurse License 
• 3+ years of experience directly managing or supervising staff in a clinical or managed care setting
• 5+ years of clinical experience
• 2+ years of experience in utilization, quality or care management within an insurance or managed care setting
• Demonstrated experience in program planning, development and evaluation

Preferred qualifications for this position include:

• Master's Degree in Nursing or another related field of Study
• Project management, Six Sigma, Lean, Change Acceleration Process (CAP) experience
• Experience with HEDIS, CAHPS, Medicare 5-Star Rating, NCQA and/or URAC accreditation

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.