The Utilization Review Nurse applies clinical nursing expertise and utilization management knowledge to determine proper patient admission status based on regulatory and reimbursement guidelines. This role supports effective utilization management processes in a healthcare setting, ensuring compliance with commercial and government payer requirements. The position requires a registered nurse with experience in nursing and utilization review or related care management functions.
Description
The Utilization Review (UR) Nurse has a strong clinical background blended with well-developed knowledge and skills in Utilization Management (UM), medical necessity and patient status determination. This individual supports the UM program by developing and maintaining effective, efficient processes for determining the appropriate admission status based on regulatory and reimbursement requirements of commercial and government payers.
Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence St. Peter Hospital 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:
Preferred Qualifications:
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.
About Providence
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.
Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts 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.
Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.
Requsition ID: 406168
Company: Providence Jobs
Job Category: Health Information Management
Job Function: Revenue Cycle
Job Schedule: Full time
Job Shift: Multiple shifts available
Career Track: Nursing
Department: 3030 UTILIZATION REVIEW WA PSPH OLYMPIA MAIN 2ND FLOOR QUALITY OFFICES
Address: WA Olympia 413 Lilly Rd NE
Work Location: Providence St Peter Hospital-Olympia
Workplace Type: On-site
Pay Range: $46.30 - $91.32
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.
PandoLogic. Category:Healthcare, Keywords:Utilization Review Nurse, Location:Tumwater, WA-98511Utilization Review Nurse, Registered Nurse, Utilization Management, Patient Admission, Medical Necessity, Care Management, Quality Management, Healthcare Compliance, Revenue Cycle, Clinical Nursing
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