Utilization Review RN - Utilization Management FT

Providence; Irvine (CA); On-site; USD 90,000 - 110,000; Full time

Job summary

Providence California Regional Services seeks an experienced Utilization Review RN for a remote, full-time 8-hour day shift position. You will conduct prospective, retrospective, and concurrent reviews, review medical records during admission, and determine medical necessity and patient status across payers.

Ideal candidates have an acute hospital case management or remote UR background, California RN license, and 2 years of relevant experience.

Qualifications

• Associate's Degree in Nursing is required.
• California RN license on hire.
• 2 years of experience in remote UR or acute hospital case management.

Responsibilities

• Perform prospective, retrospective, and concurrent utilization reviews.
• Review medical records daily during admission for all payers.
• Apply utilization management principles to determine medical necessity and patient status.
• Manage a diverse, fast-paced workload in a regulated environment with strong negotiation and decision-making skills.

Skills

Utilization management

Clinical negotiation

Communication

Decision-making

Problem-solving

Education

Associate's Degree in Nursing

California Registered Nurse License

Bachelor's Degree in Nursing

Master's Degree in Nursing

Tools

InterQual guidelines

Job description

Utilization Review RN - Remote. This position is Full-time and will work 8-hour, Day shifts.

Provide prospective, retrospective, and concurrent utilization reviews for our Southern CA 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 atProvidence California Regional Servicesand 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 DegreeinNursing.
• 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 DegreeinNursing.
• Master's DegreeinNursing.
• 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.