Utilization Review RN - Utilization Management FT

Providence Health & Services; Irvine (CA); On-site; USD 79,000 - 123,000; Full time

Benefits offered by this job

Remote work

Job summary

Providence California Regional Services is seeking an Utilization Review RN to perform prospective, retrospective, and concurrent reviews from a remote setting. This full-time role supports Southern CA ministries and requires a strong clinical background in UM, medical necessity, and patient status determination.

You will review medical records daily during admission for payers, collaborate with care teams, and navigate complex regulatory requirements.

Qualifications

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

Responsibilities

• Provide prospective, retrospective, and concurrent utilization reviews.
• Review medical records daily during admission for all payers as required by health plans.
• Demonstrate strong clinical judgment in utilization management and patient status determination.

Skills

Remote UR experience

Clinical reviews

Medical records review

Negotiation

Communication

Decision-making

Education

Associate's Degree in Nursing

California RN License

Bachelor's Degree in Nursing

Master's Degree in Nursing

Tools

InterQual guidelines

Job description

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 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 in Nursing.
• 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.

Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts 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.

Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.

About the Team

The Sisters of Providence and Sisters of St. Joseph of Orange have deep roots in California, bringing health care and education to communities from the redwood forests to the beach shores of Orange county - and everywhere in between. In Southern California, Providence provides care throughout Los Angeles County, Orange County, High Desert and beyond.

Our award-winning and comprehensive medical centers are known for outstanding programs in cancer, cardiology, neurosciences, orthopedics, women's services, emergency and trauma care, pediatrics and neonatal intensive care. Our not-for-profit network provides a full spectrum of care with leading-edge diagnostics and treatment, outpatient health centers, physician groups and clinics, numerous outreach programs, and hospice and home care, and even our own Providence High School.

Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.

Address: CA Irvine 15480 Laguna Canyon Rd

Work Location: Providence System Offices Discovery Park-Irvine

Workplace Type: Remote

Pay Range: $57.28 - $88.92

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.