Utilization Review RN

Providence; Los Angeles (CA); Hybrid; Full time

Job summary

Providence is seeking a Utilization Review RN to provide critical care coordination and utilization review services. The role necessitates a California RN license, 3 years of experience in management, and a commitment to quality healthcare. Enjoy a supportive environment with best-in-class benefits.

Benefits

Health care benefits (medical, dental, vision)

Retirement 401(k) Savings Plan with employer matching

Paid parental leave, vacations, holidays

Voluntary benefits and well-being resources

Qualifications

• 3 years of experience in utilization management and/or case management.
• 3 years of clinical experience in a hospital or medical office/clinic setting.
• Experience with Milliman criteria.

Responsibilities

• Provide utilization review and coordination of care throughout the healthcare continuum.
• Promote quality and cost-effective care to members.

Skills

Utilization management

Case management

Clinical care

Education

Nursing school graduate

California Registered Nurse License

Bachelor’s Degree in Nursing or related field

Job description

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Description

Responsible for providing utilization review and coordination of care throughout the healthcare continuum to promote quality and cost effective care to the members.

Description

Responsible for providing utilization review and coordination of care throughout the healthcare continuum to promote quality and cost effective care to the members.

Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence Medical Foundation 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

• Nursing school graduate.
• California Registered Nurse License upon hire
• 3 years of experience in utilization management and/or case management.
• 3 years of clinical experience in hospital or medical office/clinic setting.
• Experience with Milliman criteria.
  
  

Preferred Qualifications

• Bachelor’s Degree in Nursing or related field.
• Certification in Case Management (CCM) upon hire
  
  

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

Providence Clinical Network (PCN) is a service line within Providence serving patients across seven states with quality, compassionate, coordinated care. Collectively, our medical groups and affiliate practices are the third largest group in the country with over 11,000 providers, 900 clinics and 30,000 caregivers.

PCN is comprised of Providence Medical Group in Alaska, Washington, Montana and Oregon; Swedish Medical Group in Washington’s greater Puget Sound area, Pacific Medical Centers in western Washington; Kadlec in southeast Washington; Providence’s St. John’s Medical Foundation in Southern California; Providence Medical Institute in Southern California; Providence Facey Medical Foundation in Southern California; Providence Medical Foundation in Northern and Southern California; and Covenant Medical Group and Covenant Health Partners in west Texas and eastern New Mexico.

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: 371113

Company: Providence Jobs

Job Category: Health Information Management

Job Function: Revenue Cycle

Job Schedule: Full time

Job Shift: Day

Career Track: Nursing

Department: 7520 UTIL MGMT CA HERITAGE

Address: CA Mission Hills 15451 San Fernando Mission Blv

Work Location: Facey Medical Foundation Admin Office-Mission Hills

Workplace Type: Hybrid

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

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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