RN - Utilization Review

Providence; Centralia (WA); On-site; USD 85,000 - 110,000; Full time

Job summary

Providence Centralia Hospital is seeking a Utilization Review Nurse with a solid clinical background to support the UM program by determining admission status according to regulatory and payer requirements.

The role will include comprehensive UR reviews, data tracking and reporting, and cross‑department collaboration to improve processes, ensuring compliance with government and commercial payers.

Qualifications

• RN licensure in Washington required at hire.
• Minimally 3 years of nursing experience.
• Solid understanding of utilization review and medical necessity.

Responsibilities

• Perform admission, concurrent and retrospective UR reviews.
• Track, evaluate and report UR data and outcomes.
• Collaborate with multiple departments to improve UM processes.

Skills

Nursing

Utilization Review

Care Management

Discharge planning

Education

Associate's Degree in Nursing

Bachelor's Degree in Nursing

Job description

The Utilization Review (UR) Nurse has a strong clinical background blended with well-developed knowledge and skills in Utilization Management (UM), medical necessity and patient status determination. This individual supports the UM program by developing and maintaining effective, efficient processes for determining the appropriate admission status based on regulatory and reimbursement requirements of commercial and government payers. Utilizes appropriate criteria and interprets the implications of clinical status and the medical treatment plan with current federal regulations/guidelines thereby expediting the billing process, payment and preventing governmental sanction. The UR nurse is responsible for performing comprehensive admission, concurrent and retrospective UR related reviews and functions to ensure that appropriate data is tracked, evaluated and reported. This individual actively participates in process improvement initiatives, working with multiple departments and multi-disciplinary staff. This role requires current and accurate knowledge regarding commercial and government payers as well as accreditation regulations/guidelines/criteria related to UM.

Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence Centralia Hospital and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.

Required Qualifications

• Associate's DegreeinNursing.
• Upon hire: Washington Registered Nurse License.
• 3 yearsinNursing.

Preferred Qualifications

• Bachelor's DegreeinNursing.
• 3 yearsUtilization Review, Care Management, Quality Management, and/or Discharge planning.

Why Join Providence?

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.