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
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