Utilization Review RN - Case Management
About The Position
The Utilization Review (UR) Nurse has a strong clinical background blended with a 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. The UR nurse is responsible for performing admission, concurrent and retrospective UR related reviews and functions to ensure that appropriate data is tracked, evaluated and reported. This individual actively participates in process improvement initiatives, working with multiple departments and multi-disciplinary staff. This role requires current and accurate knowledge regarding commercial and government payers as well as accreditation regulations/guidelines/criteria related to UM. Providence caregivers are not simply valued – they’re invaluable. Join our team at Swedish Shared 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 empower them.
Requirements
- Bachelor's Degree in Nursing degree (BSN) from an accredited school of nursing.
- Washington Registered Nurse License upon hire.
- 3 years of Registered nursing experience in the clinical setting.
Nice To Haves
- ACM or CCM certification upon hire.
- 1 year of Case management experience.
Responsibilities
- 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.
- Performs admission, concurrent and retrospective UR related reviews and functions to ensure that appropriate data is tracked, evaluated and reported.
- Actively participates in process improvement initiatives, working with multiple departments and multi-disciplinary staff.
- Maintains current and accurate knowledge regarding commercial and government payers as well as accreditation regulations/guidelines/criteria related to UM.
Benefits
- Best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
