Providence
This is a remote role. You MUST live in the state of Washington (WA) to be considered.
Position Overview The Utilization Review (UR) Nurse has a strong clinical background and a well‑developed knowledge of Utilization Management (UM), medical necessity, and patient status determination. The role supports the UM program by developing and maintaining 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‑related reviews and ensures accurate data tracking, evaluation, and reporting. The position also involves active participation in process improvement initiatives with multidisciplinary staff.
Responsibilities
Perform admission, concurrent and retrospective utilization review (UR) assessments.
Determine appropriate admission status in accordance with payer regulations and reimbursement criteria.
Track, evaluate, and report UR data accurately and efficiently.
Participate in process improvement initiatives and collaborate with multiple departments and multidisciplinary teams.
Maintain current knowledge of commercial and government payer policies, accreditation regulations, and UM guidelines.
Required Qualifications
Bachelor's Degree in Nursing (BSN) from an accredited school of nursing.
Washington Registered Nurse License upon hire.
3 years of Registered Nursing experience in a clinical setting.
Preferred Qualifications
ACM or CCM certification upon hire.
1 year of case management experience.
Why Join Providence Providence offers a comprehensive benefits package including retirement 401(k) with employer matching, health care benefits, life and disability insurance, paid parental leave, vacation and holiday time, and well‑being resources. Our inclusive workplace values diversity and supports professional growth and financial security.
Equal Opportunity Statement Providence is an Equal Opportunity Employer. We are committed to a workforce free of unlawful discrimination, harassment, and bias on the basis of race, color, gender, disability, veteran and military status, religion, age, creed, national origin, sexual orientation, marital status, genetic information or any other basis prohibited by local, state, or federal law.
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Position Overview The Utilization Review (UR) Nurse has a strong clinical background and a well‑developed knowledge of Utilization Management (UM), medical necessity, and patient status determination. The role supports the UM program by developing and maintaining 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‑related reviews and ensures accurate data tracking, evaluation, and reporting. The position also involves active participation in process improvement initiatives with multidisciplinary staff.
Responsibilities
Perform admission, concurrent and retrospective utilization review (UR) assessments.
Determine appropriate admission status in accordance with payer regulations and reimbursement criteria.
Track, evaluate, and report UR data accurately and efficiently.
Participate in process improvement initiatives and collaborate with multiple departments and multidisciplinary teams.
Maintain current knowledge of commercial and government payer policies, accreditation regulations, and UM guidelines.
Required Qualifications
Bachelor's Degree in Nursing (BSN) from an accredited school of nursing.
Washington Registered Nurse License upon hire.
3 years of Registered Nursing experience in a clinical setting.
Preferred Qualifications
ACM or CCM certification upon hire.
1 year of case management experience.
Why Join Providence Providence offers a comprehensive benefits package including retirement 401(k) with employer matching, health care benefits, life and disability insurance, paid parental leave, vacation and holiday time, and well‑being resources. Our inclusive workplace values diversity and supports professional growth and financial security.
Equal Opportunity Statement Providence is an Equal Opportunity Employer. We are committed to a workforce free of unlawful discrimination, harassment, and bias on the basis of race, color, gender, disability, veteran and military status, religion, age, creed, national origin, sexual orientation, marital status, genetic information or any other basis prohibited by local, state, or federal law.
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