Utilization Review RN - Remote at Providence
United States
<p><strong>Utilization Review RN - Remote</strong></p><p>The RN Care Coord-Qual Med Mgmt will provide administration of medical management programs that include: prior authorization, concurrent hospital and skilled nursing review, appeals and grievance, delegation, medical policy development and medical claims audits. These programs are developed to manage medical expense, determine medically appropriate services and define clinical criteria for decision making. This includes retrospective review of claims and other data, as well as care coordination and discharge planning.</p><p><span>Providence Health Plan caregivers are not simply valued – they’re invaluable. Join our team at Providence Health Plan Partners 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.</span></p><p><span><strong>This position works 100% remote and is open to candidates residing in:</strong></span></p><ul><li><span>Oregon</span></li><li><span>Washington</span></li></ul><p><strong>Required Qualifications: </strong></p><ul><li>5 years Clinical nursing experience.</li><li>Upon hire: Oregon Registered Nurse License and Washington State Registered Nurse License</li><li>Experience working with physicians in collaboration and management of patient care.</li></ul><p><strong>Preferred Qualifications: </strong></p><ul><li>Bachelor's Degree Nursing or health care.</li><li>Utilization review, discharge planning and/or managed care experience.</li><li><span data-teams="true">Psychiatric Mental Health Nurse Certification </span><span style="font-size:inherit;" data-teams="true">PMH-BC</span></li></ul><p style="margin:0in;"><span style="font-family:"Calibri",sans-serif;"><span style="font-size:11.0pt;"><strong>Salary Range by Location:</strong></span></span></p><p style="margin:0in;"> </p><p style="margin:0in;"><span style="font-family:"Calibri",sans-serif;"><span style="font-size:11.0pt;"><strong>Oregon: Non-Portland Service Area: Min: $45.90, Max: $71.40</strong></span></span></p><p style="margin:0in;"><span style="font-family:"Calibri",sans-serif;"><span style="font-size:11.0pt;"><strong>Oregon: Portland Service Area: Min: $49.34, Max: $76.59</strong></span></span></p><p style="margin:0in;"><span style="font-family:"Calibri",sans-serif;"><span style="font-size:11.0pt;"><strong>Washington: Western: $51.43, Max: $79.84</strong></span></span></p><p style="margin:0in;"><span style="font-family:"Calibri",sans-serif;"><span style="font-size:11.0pt;"><strong>Washington: Southwest - Olympia, Centralia & Below: Min: $49.34, Max: $76.59 </strong></span></span></p><p style="margin:0in;"><span style="font-family:"Calibri",sans-serif;"><span style="font-size:11.0pt;"><strong>Washington: Eastern: Min: $43.90, Max: $68.16</strong></span></span></p><p style="margin:0in;"><span style="font-family:"Calibri",sans-serif;"><span style="font-size:11.0pt;"><strong>Washington: South Eastern: Min: $45.90, Max: $71.40</strong></span></span></p><p style="margin:0in;"> </p><p style="margin-left:0cm;"><strong>Why Join Providence Health Plan? </strong></p><p style="margin-left:0cm;">Our <a href="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" target="_blank" rel="nofollow">best-in-class benefits</a> 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 <a href="https://providence.jobs/mission/" target="_blank" rel="nofollow">Mission</a> of caring for everyone, especially the most vulnerable in our communities.</p><p>Accepting a new position at another facility that is part of the Providence family of organizations may change your current benefits. Changes in benefits, including paid time-off, happen for various reasons. These reasons can include changes of Legal Employer, FTE, Union, location, time-off plan policies, availability of health and welfare benefit plan offerings, and other various reasons. </p> <br><br/> <div> </div> <div> <div> 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. </div> <div> <br/> </div> <div> 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. </div> <div> <br/> </div> <div> 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 <a href="https://providence.jobs/benefits/" target="_blank" rel="nofollow">providence.jobs/benefits</a>. </div> <div> <br/> </div> <div> Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the <a href="https://s3-us-west-2.amazonaws.com/images.provhealth.org/HR-onboarding/LA_County_Fair_Chance_Ordinance_2024.pdf" target="_blank" rel="nofollow">Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act</a>. </div> </div>
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