RN Utilization Review Part- time Day

Providence; Mission Hills (KS); Remote; USD 60,000 - 80,000; Full time

Job summary

A healthcare organization in Mission Hills, KS, is seeking a Utilization Management RN to conduct clinical reviews and manage a diverse workload. This position requires an Associate's Degree in Nursing and a California RN License, along with strong negotiation and problem-solving skills. Ideal candidates will have experience in a remote UR environment and familiarity with Interqual guidelines.

Benefits

Best-in-class benefits

Support for professional growth

Inclusive workplace

Qualifications

• 2 years experience in a remote UR environment or as an acute hospital case manager.
• Experience working with Interqual guidelines is preferred.
• Bachelor's or Master's Degree in Nursing is preferred.

Responsibilities

• Conduct clinical reviews and review medical records daily.
• Manage workload in a fast-paced regulatory environment.
• Provide utilization reviews for LA ministries.

Skills

Utilization Management

Clinical background

Negotiation skills

Communication skills

Problem-solving skills

Decision-making skills

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.

About the Role

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.

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.

Equal Opportunity Employer

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.