Utilization Review RN *Per Diem*

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

Job summary

A leading healthcare organization seeks a Utilization Review RN for a remote, Per-Diem role. The candidate will manage clinical reviews and utilization processes, requiring a strong nursing background and excellent communication skills. This position demands flexibility with shifts, ensuring quality care in a dynamic healthcare setting.

Benefits

Best-in-class benefits

Support for professional growth

Focus on caring for vulnerable communities

Qualifications

• 2 years of experience in remote UR or as acute hospital case manager.
• Experience with InterQual guidelines preferred.
• Experience in a multi-hospital and/or integrated healthcare system 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

Negotiation

Communication

Problem-solving

Decision-making

Education

Associate's Degree in Nursing

California Registered Nurse License

Bachelor's Degree or Master's Degree in Nursing

Job 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 the company

Providence Health & Services is a not-for-profit, Catholic health care system operating multiple hospitals across seven states, with headquarters in Renton, Washington. The Providence affiliate family includes: Covenant Health, Facey Medical Group,Kadlec, Pacific Medical Centers and Swedish Health Services.

Notice

Talentify is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

Talentify provides reasonable accommodations to qualified applicants with disabilities, including disabled veterans. Request assistance at [e-mail] or 407-000-0000.

Federal law requires every new hire to complete Form I-9 and present proof of identity and U.S. work eligibility.

An Automated Employment Decision Tool (AEDT) will score your job-related skills and responses. Bias-audit & data-use details: www.talentify.io/bias-audit-report . NYC applicants may request an alternative process or accommodation at [e-mail] or 407-000-0000.