Utilization Review RN: Evening Impact & Compliance

Providence Health and Services; Mount Rainier (MD); On-site; USD 70,000 - 109,000; Part time

Benefits offered by this job

Fantastic benefits

Job summary

Providence Health and Services is seeking a part-time Utilization Review RN at Swedish Medical Center in Seattle. The role focuses on determining admission status and medical necessity, performing UR reviews, and supporting multidisciplinary teams.

The UR nurse will collaborate with case management, providers, and payer teams to optimize reimbursement and ensure compliance with regulations. A BSN and WA RN license are required, with CCM/ACM certifications and case management experience preferred.

Qualifications

• Bachelor’s Degree Nursing (BSN) from an accredited school.
• Washington RN license required.
• Minimum 3 years RN experience in clinical setting.
• ACM or CCM certification preferred.
• 1 year case management experience preferred.

Responsibilities

• Perform Utilization Review (UR) including admission, concurrent and retrospective reviews.
• Collaborate with providers, compliance, contracting, revenue cycle and physician advisors on medical necessity matters.
• Submit clinical data and obtain authorizations for concurrent and hospital stays after discharge; handle appeals as applicable.
• Provide education and training to staff regarding utilization management processes, reimbursement patterns and regulations.
• Escalate issues to Case Management leadership and coordinate with multiple departments as needed.

Education

Bachelor’s Degree in Nursing (BSN)

Washington RN license

ACM certification

CCM certification

Job description

Providence Health and Services is seeking a part-time Utilization Review RN at Swedish Medical Center in Seattle. The role focuses on determining admission status and medical necessity, performing UR reviews, and supporting multidisciplinary teams.

The UR nurse will collaborate with case management, providers, and payer teams to optimize reimbursement and ensure compliance with regulations. A BSN and WA RN license are required, with CCM/ACM certifications and case management experience preferred.