Utilization Review RN
About The Position
This is a remote, part-time Utilization Review RN position working 8-hour day shifts. The role involves providing prospective, retrospective, and concurrent utilization reviews for Southern CA ministries. Responsibilities include conducting clinical reviews and reviewing medical records daily during admission for all payers, as required by health plans. The position demands a strong clinical background with expertise in Utilization Management, medical necessity, and patient status determination. The ideal candidate will effectively manage a diverse workload in a fast-paced, regulatory environment, showcasing excellent negotiation, communication, problem-solving, and decision-making skills. Providence caregivers are valued and empowered in a culture of patient-focused, whole-person care.
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 Southern CA ministries.
- Conduct clinical reviews and review medical records daily during admission for all payers, as required by the health plans.
Benefits
- Best-in-class benefits 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
Part-time
Career Level
Mid Level
Education Level
Associate degree
