Utilization Review RN - Case Management Specialist

Providence; Mission Hills (CA); On-site; USD 79,000 - 122,000; Full time

Job summary

Providence is seeking a nurse to lead utilization review and coordinate care across the healthcare continuum, promoting quality and cost-effective outcomes for members. The role emphasizes a patient-focused culture and team collaboration across Providence Medical Foundation.

Ideal candidates will have RN licensure in California, 3 years of utilization/case management experience, and clinical hospital/clinic experience.

Qualifications

• Nursing school graduate.
• Upon hire: California Registered Nurse License.
• 3 years' experience in utilization management and/or case management.
• 3 years Clinical experience in hospital or medical office/clinic setting.
• Experience with Milliman criteria.
• Bachelor's Degree in Nursing or related field (preferred).
• Upon hire: CCM certification (preferred).

Education

Nursing school graduate

California RN license

3 years' experience in utilization management

3 years Clinical experience in hospital/clinic

Experience with Milliman criteria

Bachelor's Degree in Nursing or related field

Certification in Case Management (CCM)

Job description

Providence is seeking a nurse to lead utilization review and coordinate care across the healthcare continuum, promoting quality and cost-effective outcomes for members. The role emphasizes a patient-focused culture and team collaboration across Providence Medical Foundation.

Ideal candidates will have RN licensure in California, 3 years of utilization/case management experience, and clinical hospital/clinic experience.