Utilization Review Nurse: Clinical UM & Care Management

Providence; Centralia (WA); On-site; USD 85,000 - 105,000; Full time

Job summary

Providence Centralia Hospital is seeking a Utilization Review (UR) Nurse to support the UM program by determining admission status based on regulatory and payer requirements. The role involves reviewing admissions and data management to expedite billing, while ensuring compliance with commercial and government payers and accreditation guidelines.

Collaboration with multi-disciplinary teams is essential. The ideal candidate has an Associate’s Degree in Nursing, Oregon/Washington RN license on

Qualifications

• Associate's Degree in Nursing required.
• Washington RN license required upon hire.
• Minimum 3 years of nursing experience.
• Bachelor's Degree in Nursing preferred.
• 3 years in Utilization Review, Care Management, Quality Management, or Discharge planning preferred.

Responsibilities

• Perform comprehensive admission, concurrent and retrospective UR reviews.
• Track, evaluate and report UR data.
• Participate in process improvement with multiple departments.

Skills

Utilization Review

Utilization Management

Nursing

Process improvement

Education

Associate's Degree in Nursing

Bachelor's Degree in Nursing

Job description

Providence Centralia Hospital is seeking a Utilization Review (UR) Nurse to support the UM program by determining admission status based on regulatory and payer requirements. The role involves reviewing admissions and data management to expedite billing, while ensuring compliance with commercial and government payers and accreditation guidelines.

Collaboration with multi-disciplinary teams is essential. The ideal candidate has an Associate’s Degree in Nursing, Oregon/Washington RN license on