Utilization Review RN

Company: Providence
Location: Apple Valley
Posted on: March 19, 2023

Job Description:

DescriptionProvide 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.Required qualifications:

• Associate's Degree in Nursing.
• Required 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.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 ProvidenceAt 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.Check out our benefits page for more information about our Benefits and Rewards.About the TeamThe 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.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.We are committed to cultural diversity and equal employment for all individuals. It is our policy to recruit, hire, promote, compensate, transfer, train, retain, terminate, and make all other employment-related decisions without regard to race, color, religious creed (including religious dress and grooming practices), national origin (including certain language use restrictions), ancestry, disability (mental and physical including HIV and AIDS), medical condition (including cancer and genetic characteristics), genetic information, marital status, age, sex (which includes pregnancy, childbirth, breastfeeding and related medical conditions), gender, gender identity, gender expression, sexual orientation, genetic information, and military and veteran status or any other applicable legally protected status. We will also provide reasonable accommodation to known physical or mental limitations of an otherwise qualified caregiver or applicant for employment, unless the accommodation would impose undue hardship on the operation of our business.We are a community where all people, regardless of differences, are welcome, secure, and valued. We value respect, appreciation, collaboration, diversity, and a shared commitment to serving our communities. We expect that all workforce members in our community will act in ways which reflect a commitment to and accountability for, racial and social justice and equality in the workplace. As such, we will maintain a workplace free of discrimination and harassment based on any applicable legally protected status. We also expect that all workforce members will maintain a positive workplace free from any unacceptable conduct which creates an intimidating, hostile, or offensive work environment.Requsition ID: 169812Company: Providence JobsJob Category: Health Information ManagementJob Function: Revenue CycleJob Schedule: Full timeJob Shift: DayCareer Track: NursingDepartment: 7550 SMMC CASE MGMTAddress: CA Apple Valley 18300 Hwy 18Pay Range: $45.86 - $71.65The 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.Check out our benefits page for more information about our Benefits and Rewards.Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate 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.

Keywords: Providence, Apple Valley , Utilization Review RN, Healthcare , Apple Valley, California