Description
The Utilization Review RN provides assessment and analytical support to concurrent and retrospective quality and utilization activities, in accordance with the Providence Hospital Quality and Utilization Plans, Medicare regulations, The Joint Commission regulations, guidelines and direction received from Administration and the Medical Staff. Works as a catalyst to promote coordination of care, continuity of care in the achievement of consistent and/or expected clinical conditions and is a patient advocate in utilization of efficient resource management. Coordinates the care for complex patients from pre-admission to immediate post-discharge. Participates in facilitating coordination and communication between all members of the health care team, in the decision making process to minimize fragmentation of the care delivery system and prevent hospital readmissions. The Utilization Review RN assists the health system in assuring financial viability by performing comprehensive medical reviews utilizing appropriateness criteria and interpreting implication of clinical status / medical treatment plan with current federal regulations guidelines; thereby facilitating accurate and timely billing process and payment, consistent with regulatory requirements.
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Providence caregivers are not simply valued - they're invaluable. Join our team at Providence Centralia Hospital 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: Washington Registered Nurse License.
- 3 years Medical-surgical (or comparable acute care) nursing experience.
Preferred Qualifications:
- Bachelor's Degree in Nursing or health-related field or equivalent educ/experience.
- 1 year Recent acute care experience.
- Quality and/or utilization review and/or case management experience.
- Microsoft Office (Word and Excel) experience.
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.
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.
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.
About the Team
Providence has been serving the Pacific Northwest since 1856 when Mother Joseph and four other Sisters of Providence arrived in Vancouver, Washington Territory. Today, Providence is the largest health care provider in Washington located in communities large and small across the state. In western Washington, Providence provides care throughout the greater Puget Sound from Snohomish County to Lewis County.
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 also 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.
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.
Requsition ID: 328067
Company: Providence Jobs
Job Category: Care Management
Job Function: Clinical Care
Job Schedule: Full time
Job Shift: Day
Career Track: Nursing
Department: 3033 UTILIZATION REVIEW WA PCH CENTRALIA HOSPITAL
Address: WA Centralia 914 S Scheuber Rd
Work Location: Centralia Hospital-Centralia
Workplace Type: On-site
Pay Range: $45.22 - $71.58
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.