Remote Utilization Review RN – Day Shift, Full-Time

Providence; Irvine (CA); On-site; USD 90,000 - 110,000; Full time

Job summary

Providence California Regional Services seeks an experienced Utilization Review RN for a remote, full-time 8-hour day shift position. You will conduct prospective, retrospective, and concurrent reviews, review medical records during admission, and determine medical necessity and patient status across payers.

Ideal candidates have an acute hospital case management or remote UR background, California RN license, and 2 years of relevant experience.

Qualifications

• Associate's Degree in Nursing is required.
• California RN license on hire.
• 2 years of experience in remote UR or acute hospital case management.

Responsibilities

• Perform prospective, retrospective, and concurrent utilization reviews.
• Review medical records daily during admission for all payers.
• Apply utilization management principles to determine medical necessity and patient status.
• Manage a diverse, fast-paced workload in a regulated environment with strong negotiation and decision-making skills.

Skills

Utilization management

Clinical negotiation

Communication

Decision-making

Problem-solving

Education

Associate's Degree in Nursing

California Registered Nurse License

Bachelor's Degree in Nursing

Master's Degree in Nursing

Tools

InterQual guidelines

Job description

Providence California Regional Services seeks an experienced Utilization Review RN for a remote, full-time 8-hour day shift position. You will conduct prospective, retrospective, and concurrent reviews, review medical records during admission, and determine medical necessity and patient status across payers.

Ideal candidates have an acute hospital case management or remote UR background, California RN license, and 2 years of relevant experience.