RN Utilization Review Part- time Day

Providence Health & Services; Mission Hills (CA); Remote; USD 80,000 - 100,000; Full time

Job summary

A healthcare organization in California is seeking a Utilization Management RN. The role involves conducting daily clinical reviews, managing a diverse workload, and requires a strong clinical background along with skills in communication, negotiation, and problem-solving. Join a team that values patient-focused care and supports its caregivers with best-in-class benefits.

Benefits

Best-in-class benefits

Qualifications

• 2 years of experience working in a remote UR environment or as an acute hospital case manager.
• Experience working with Interqual guidelines preferred.
• Experience in a multi-hospital and/or integrated healthcare system is a plus.

Responsibilities

• Provide prospective, retrospective, and concurrent utilization reviews daily.
• Conduct clinical reviews and review medical records for admissions.
• Effectively manage diverse workload in a fast-paced environment.

Skills

Utilization Management

Negotiation

Communication

Problem-solving

Decision-making

Education

Associate's Degree Nursing

California Registered Nurse License

Job description

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 Nursing.
• Upon hire: California Registered Nurse License.
• 2 years Experience working in a remote UR environment or working as an acute hospital case manager.

Preferred Qualifications

• Bachelor's Degree Nursing.
• Master's Degree 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.