Utilization Review RN - Full-time (Remote)

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' 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
[https://nam11.safelinks.protection.outlook.com/?url=https%3A%2F%2Fprovidence.jobs%2Fbenefits%2F&data=05%7C01%7Cethelleah.torres1%40providence.org%7C6da11282629946c936bc08dbf64b1e78%7C2e3190869a2646a3865f615bed576786%7C0%7C0%7C638374574718197112%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=CHUc7JRL0t6AAExYx6UfCEVEH8gfmaw9cEOZ4wX0%2BZU%3D&reserved=0] 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 [https://providence.jobs/mission/] of caring
for everyone, especially the most vulnerable in our communities.

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
[https://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
[https://s3-us-west-2.amazonaws.com/images.provhealth.org/HR-onboarding/LA_County_Fair_Chance_Ordinance_2024.pdf].

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
[https://www.providenceiscalling.jobs/eeo/]. 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 [https://providence.jobs/diversity/] makes us
stronger, so we are dedicated to shaping an inclusive workforce, learning from
each other, and creating equal opportunities for advancement.