Remote Utilization Review RN Full-time Day Shift

Providence Health & Services; Irvine (CA); On-site; USD 79,000 - 123,000; Full time

Benefits offered by this job

Remote work

Job summary

Providence California Regional Services is seeking an Utilization Review RN to perform prospective, retrospective, and concurrent reviews from a remote setting. This full-time role supports Southern CA ministries and requires a strong clinical background in UM, medical necessity, and patient status determination.

You will review medical records daily during admission for payers, collaborate with care teams, and navigate complex regulatory requirements.

Qualifications

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

Responsibilities

• Provide prospective, retrospective, and concurrent utilization reviews.
• Review medical records daily during admission for all payers as required by health plans.
• Demonstrate strong clinical judgment in utilization management and patient status determination.

Skills

Remote UR experience

Clinical reviews

Medical records review

Negotiation

Communication

Decision-making

Education

Associate's Degree in Nursing

California RN License

Bachelor's Degree in Nursing

Master's Degree in Nursing

Tools

InterQual guidelines

Job description

Providence California Regional Services is seeking an Utilization Review RN to perform prospective, retrospective, and concurrent reviews from a remote setting. This full-time role supports Southern CA ministries and requires a strong clinical background in UM, medical necessity, and patient status determination.

You will review medical records daily during admission for payers, collaborate with care teams, and navigate complex regulatory requirements.