RN - Utilization Review

Providence; Los Angeles (CA); Remote; Part time

Job summary

Join a leading healthcare provider as an RN in Utilization Review, working remotely in California. This part-time role involves conducting clinical reviews and managing a diverse workload in a fast-paced environment. Ideal candidates will have a strong clinical background and experience in utilization management.

Benefits

Comprehensive benefits package

401(k) Savings Plan with employer matching

Health care benefits (medical, dental, vision)

Paid parental leave

Voluntary benefits and well-being resources

Qualifications

• 2 years of experience in a remote UR environment or as an acute hospital case manager.
• Experience with InterQual guidelines preferred.

Responsibilities

• Provide prospective, retrospective, and concurrent utilization reviews.
• Conduct clinical reviews and review medical records daily.

Skills

Negotiation

Communication

Problem-solving

Decision-making

Education

Associate's Degree in Nursing

California Registered Nurse License

Bachelor's Degree or Master's Degree in Nursing

Job description

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Description

RN - Utilization Review for our centralized Utilization Management team for Southern California. This position is Remote (Working from Home 100%) and will work Part-Time, 8-hour Day shifts (20 hours per week). Successful candidates will reside/work in California.

Description

RN - Utilization Review for our centralized Utilization Management team for Southern California. This position is Remote (Working from Home 100%) and will work Part-Time, 8-hour Day shifts (20 hours per week). Successful candidates will reside/work in California.

Provide prospective, retrospective, and concurrent utilization reviews for our LA ministries. Conduct clinical reviews and review medical records daily during admission for all payers, as required by the health plans. This role requires a strong clinical background combined with well-developed knowledge and skills in Utilization Management, medical necessity, and patient status determination. The Utilization Management RN must effectively and efficiently manage a diverse workload in a fast-paced, rapidly changing regulatory environment, demonstrating excellent negotiation, communication, problem-solving, and decision-making skills.

Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence California Regional Services 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 Degree in Nursing.
• Upon hire: California Registered Nurse License
• 2 years of experience working in a remote UR environment or working as an acute hospital case manager.
  
  

Preferred Qualifications

• Bachelor's Degree Or Master's Degree in Nursing.
• Experience working with InterQual guidelines.
• Experience in a multi-hospital and/or integrated healthcare system.
  
  

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.

About Providence

At 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.

Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits.

About The Team

The 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.

Providence is proud to be an Equal Opportunity Employer. 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 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. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.

Requsition ID: 366187

Company: Providence Jobs

Job Category: Health Information Management

Job Function: Revenue Cycle

Job Schedule: Part time

Job Shift: Day

Career Track: Nursing

Department: 7000 UTILIZATION MGMT REMOTE

Address: CA Mission Hills 15031 Rinaldi St

Work Location: Providence Holy Cross Medical Ctr-Mission Hills

Workplace Type: Remote

Pay Range: $56.44 - $87.63

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.

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Part-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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