RN Utilization Review Part- time Remote
About The Position
RN Utilization Review at Providence Holy Cross Medical Center in Mission Hills, CA. This position is Part- time and will work 8-hour, Day shifts. Providence Holy Cross Medical Center is four-time designated for Magnet status, the highest recognition for nursing excellence, making it one of just four hospitals in California to achieve this status. Since 2007, Holy Cross has been recognized as a Magnet hospital-a prestigious designation from the American Nurses Credentialing Center (ANCC), which recognizes organizations that provide the highest-quality care. Only 9.96% of U.S. hospitals earn Magnet recognition, which means that only 1% of U.S. hospitals are four times designated. 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. 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.
Requirements
- Associate's Degree - Nursing.
- California Registered Nurse License upon hire.
- 2 years - Experience working in a remote UR environment or working as an acute hospital case manager.
Nice To Haves
- 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.
- 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.
Benefits
- Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security.
- 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.
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What This Job Offers
Job Type
Part-time
Industry
Hospitals
Education Level
Associate degree
Number of Employees
5,001-10,000 employees
