Utilization Review Nurse — Clinical Care & Compliance

Providence Swedish Medical Center; Centralia (WA); On-site; USD 69,000 - 107,000; Full time

Job summary

Providence Centralia Hospital is seeking an Utilization Review (UR) Nurse with strong clinical background to support the UM program by determining admission status per regulatory and payer requirements. This role conducts UR reviews and works with multidisciplinary staff to improve processes and data tracking, ensuring compliance with UM guidelines.

The position emphasizes knowledge of government and commercial payers, accreditation standards, and continuous process improvement within a

Qualifications

• Associate's Degree required and RN license current in WA.
• Bachelor's degree preferred for advanced roles.
• Minimum 3 years nursing experience; UR/Care Management exposure valued.

Responsibilities

• Perform admission, concurrent and retrospective UR reviews.
• Track, evaluate and report data related to UM processes.
• Collaborate with multi-disciplinary teams to improve workflows.

Education

Associate's Degree in Nursing

Washington Registered Nurse License

Bachelor's Degree in Nursing

Tools

Utilization Review knowledge

Job description

Providence Centralia Hospital is seeking an Utilization Review (UR) Nurse with strong clinical background to support the UM program by determining admission status per regulatory and payer requirements. This role conducts UR reviews and works with multidisciplinary staff to improve processes and data tracking, ensuring compliance with UM guidelines.

The position emphasizes knowledge of government and commercial payers, accreditation standards, and continuous process improvement within a