Remote Utilization Review RN — Full-Time

Santa Barbara Cottage Hospital; United States; Remote; USD 90,000 - 110,000; Full time

Job summary

Providence California Regional Services is seeking a Utilization Review RN for a remote, full-time position with day shifts. You will conduct prospective, retrospective, and concurrent reviews and review medical records daily for all payers.

The role requires an active California RN license, an Associate's Degree in Nursing, and at least two years in remote UR or hospital case management, with additional preferred degrees in nursing and experience with Interqual guidelines.

Qualifications

• Requires an active California RN license and an Associate's Degree in Nursing.
• Two years of experience in remote utilization review or hospital case management.
• Knowledge of utilization management, medical necessity, and patient status determination.

Responsibilities

• Provide prospective, retrospective, and concurrent utilization reviews.
• Review medical records daily during admission for all payers.
• Manage a diverse workload in a fast-paced regulatory environment.
• Engage in negotiation and effective communication with care teams.

Skills

Remote UR experience

Clinical review skills

Negotiation & communication

Education

Associate's Degree in Nursing

California RN License

Bachelor's Degree in Nursing

Master's Degree in Nursing

Job description

Providence California Regional Services is seeking a Utilization Review RN for a remote, full-time position with day shifts. You will conduct prospective, retrospective, and concurrent reviews and review medical records daily for all payers.

The role requires an active California RN license, an Associate's Degree in Nursing, and at least two years in remote UR or hospital case management, with additional preferred degrees in nursing and experience with Interqual guidelines.