Utilization Review RN

Providence; Los Angeles (CA); Remote; USD 60,000 - 80,000; Part time

Job summary

A leading health organization is seeking an RN - Utilization Review to join their centralized Utilization Management team. This position is remote and per-diem, requiring strong clinical skills and experience in utilization management to provide comprehensive reviews for various patients in Southern California. Candidates should be prepared to work at least 4-6 shifts per month, and must hold a California Registered Nurse License.

Benefits

Comprehensive benefits package

Retirement 401(k) Savings Plan with employer matching

Flexible work shifts

Qualifications

• 2 years experience in remote UR or as an acute hospital case manager.
• Experience with InterQual guidelines preferred.

Responsibilities

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

Skills

Clinical reviews

Utilization Management

Negotiation

Problem-solving

Communication

Education

Associate's Degree in Nursing

California Registered Nurse License

Job description

2 days ago Be among the first 25 applicants

Description

RN - Utilization Review for our centralized Utilization Management team for Southern California. This position is Remote (Working from Home 100%) and Per-Diem, When working a shift it will be a 8-hour Day shifts. Expectations of working Per-Diem are at least 4-6 shifts per month including weekend rotations. Successful candidates will reside/work in California.

Description

RN - Utilization Review for our centralized Utilization Management team for Southern California. This position is Remote (Working from Home 100%) and Per-Diem, When working a shift it will be a 8-hour Day shifts. Expectations of working Per-Diem are at least 4-6 shifts per month including weekend rotations. Successful candidates will reside/work in California.

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

Preferred Qualifications

• Bachelor's Degree Or Master's Degree in 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. 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.

Requsition ID: 369652

Company: Providence Jobs

Job Category: Health Information Management

Job Function: Revenue Cycle

Job Schedule: Full time

Job Shift: Multiple shifts available

Career Track: Nursing

Department: 7000 UTILIZATION MGMT REMOTE

Address: CA Mission Hills 15031 Rinaldi St

Work Location: Providence Holy Cross Medical Ctr-Mission Hills

Workplace Type: On-site

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

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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