RN Utilization Review - Full-time Days - REMOTE
About The Position
Description RN Utilization Review at Irvine, CA. This position is Full- time and will work Remote 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. 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
- Upon hire: California Registered Nurse License
- 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 Southern CA 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
- Demonstrate 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.
- 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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What This Job Offers
Job Type
Full-time
Education Level
Associate degree
Number of Employees
5,001-10,000 employees
