Utilization Review RN

Providence Health & Services • Part-time • Apple Valley, CA, US • $54 - $82 / hour • 1w ago

Description

Provide prospective, retrospective and concurrent utilization review for St. Mary Medical Center. Provide clinical reviews and medical records daily during admission for all payers as required by the health plans.

Requires a strong clinical background blended with a well-developed knowledge and skills in Utilization Management, medical necessity and patient status determination.

The UM nurse effectively and efficiently manages a diverse workload in a fast paced, rapidly changing regulatory environment with excellent negotiation, communication, problem solving and decision making skills.

Providence caregivers are not simply valued – they’re invaluable. Join our team at St. Mary Medical Center 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:

Associate's Degree in Nursing.
Upon hire: California Registered Nurse License
1 year experience working in a remote UR environment or 2 years experience working as an acute hospital case manager

Preferred qualifications:

Bachelor's Degree in Nursing or
Master's Degree in Nursing.
Case Management Certification upon hire
Experience working with Interqual guidelines.
2 years Experience as a case manager in an acute care setting.
Experience in a multi-hospital and/or integrated healthcare system.

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.

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.

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.

About The Team

The Sisters of Providence and Sisters of St. Joseph of Orange have deep roots in California, bringing health care and education to communities from the redwood forests to the beach shores of Orange county - and everywhere in between. In Southern California, Providence provides care throughout Los Angeles County, Orange County, High Desert and beyond.

Our award-winning and comprehensive medical centers are known for outstanding programs in cancer, cardiology, neurosciences, orthopedics, women's services, emergency and trauma care, pediatrics and neonatal intensive care. Our not-for-profit network provides a full spectrum of care with leading-edge diagnostics and treatment, outpatient health centers, physician groups and clinics, numerous outreach programs, and hospice and home care, and even our own Providence High School.

Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.

Requsition ID: 323388

Company: Providence Jobs

Job Category: Health Information Management

Job Function: Revenue Cycle

Job Schedule: Part time

Job Shift: Day

Career Track: Nursing

Department: 7550 SMMC CASE MGMT

Address: CA Apple Valley 18300 Hwy 18

Work Location: St Mary Medical Center-Apple Valley

Workplace Type: On-site

Pay Range: $54.43 - $82.66

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.

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