Swedish
About the Role
The Utilization Review (UR) Nurse is a remote position requiring residency in the state of Washington (WA). This role supports the Utilization Management (UM) program by developing and maintaining efficient processes for determining appropriate admission status based on regulatory and reimbursement requirements of commercial and government payers. The UR nurse performs admission, concurrent, and retrospective UR reviews, tracks and reports data, and actively participates in process improvement initiatives with multiple departments and multidisciplinary staff.
Responsibilities
Perform admission, concurrent, and retrospective utilization reviews to evaluate medical necessity.
Maintain accurate and current knowledge of commercial and government payers, accreditation regulations, and UM guidelines.
Track, evaluate, and report UR data to support program performance.
Collaborate with care teams and departments to improve processes and outcomes.
Serve on a day‑shift, per‑diem/on‑call basis.
Required Qualifications
Bachelor's Degree in Nursing (BSN) from an accredited school of nursing.
Washington Registered Nurse license upon hire.
Three (3) years of registered nursing experience in a clinical setting.
Preferred Qualifications
ACM or CCM certification upon hire.
One (1) year of case management experience.
Benefits and Compensation $51.43 – $79.84 per hour base pay range. Additional compensation may be available for shift differentials, on‑call, overtime, premiums, bonuses and other incentives. The position offers a comprehensive benefits package including a 401(k) retirement plan with employer matching, medical, dental, vision, life and disability insurance, paid leave, and other wellness resources.
About Providence Providence is an integrated health system dedicated to improving health and wellbeing. Our culture values patient‑focused, whole‑person care built on understanding, commitment, and mutual respect. You will be part of a team that serves 120,000 caregivers across over 50 hospitals, 1,000+ clinics, and a full range of health and social services in Washington and beyond.
Equal Employment Opportunity Statement Providence is a proud equal opportunity employer. We are committed to a workplace free from unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran or military status, religion, age, creed, national origin, sexual identity or expression, marital status, genetic information, or any other basis prohibited by law.
Requisition ID 392045
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Responsibilities
Perform admission, concurrent, and retrospective utilization reviews to evaluate medical necessity.
Maintain accurate and current knowledge of commercial and government payers, accreditation regulations, and UM guidelines.
Track, evaluate, and report UR data to support program performance.
Collaborate with care teams and departments to improve processes and outcomes.
Serve on a day‑shift, per‑diem/on‑call basis.
Required Qualifications
Bachelor's Degree in Nursing (BSN) from an accredited school of nursing.
Washington Registered Nurse license upon hire.
Three (3) years of registered nursing experience in a clinical setting.
Preferred Qualifications
ACM or CCM certification upon hire.
One (1) year of case management experience.
Benefits and Compensation $51.43 – $79.84 per hour base pay range. Additional compensation may be available for shift differentials, on‑call, overtime, premiums, bonuses and other incentives. The position offers a comprehensive benefits package including a 401(k) retirement plan with employer matching, medical, dental, vision, life and disability insurance, paid leave, and other wellness resources.
About Providence Providence is an integrated health system dedicated to improving health and wellbeing. Our culture values patient‑focused, whole‑person care built on understanding, commitment, and mutual respect. You will be part of a team that serves 120,000 caregivers across over 50 hospitals, 1,000+ clinics, and a full range of health and social services in Washington and beyond.
Equal Employment Opportunity Statement Providence is a proud equal opportunity employer. We are committed to a workplace free from unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran or military status, religion, age, creed, national origin, sexual identity or expression, marital status, genetic information, or any other basis prohibited by law.
Requisition ID 392045
#J-18808-Ljbffr