Provide prospective, retrospective, and concurrent utilization reviews for our LA 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 - Nursing.
California Registered Nurse License upon hire.
2 years - Experience working in a remote UR environment or working as an acute hospital case manager.
Preferred Qualifications:
Bachelor's Degree - Nursing.
Master's Degree - Nursing.
Experience working with Interqual guidelines.
Experience in a multi-hospital and/or integrated healthcare system.
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.
Check out our benefits page for more information about our Benefits and Rewards.
About the Team
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. 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: 289945
Company: Providence Jobs
Job Category: Health Information Management
Job Function: Revenue Cycle
Job Schedule: Part time
Job Shift:
Career Track: Nursing
Department: 7000 UTILIZATION MGMT CA SOCAL
Address: CA Mission Hills 15031 Rinaldi St
Work Location: Providence Holy Cross Medical Ctr-Mission Hills
Pay Range: $52.46 - $83.05
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.
Check out our benefits page for more information about our Benefits and Rewards.
Sylvan Learning of Durham & Chapel Hill is looking for enthusiastic tutors to join our community of superstar educators who deliver in-person and online tutoring to Sylvan students. If you are motivated to make a difference by supporting the ever-growing need for educational...
Join the family at Progressive Roofing, a leader in the roofing industry with over 40 years of excellence and dedication to quality. We specialize in metal roofing for commercial projects and are seeking a skilled Metal Commercial Roofer to expand our talented team. This...
...Job Description Description The Instructional Systems Designer will be responsible for designing, developing, and supporting the execution... ...-tiered curriculum that supports contractors - from entry-level professionals with one year of experience to senior experts...
...Concrete Finisher The Concrete Finisher is responsible for finishing concrete pours and other laborer requirements associated with the process. Benefits offered: ~ Highly competitive pay ~ Health insurance, including medical, dental and vision options ~4...
...Join the Prep Academy Tutors Team Where Passion Meets Opportunity! At Prep Academy Tutors , we're on a mission to ignite the love... ...achieve their fullest potential. We're a dynamic, private in-home and online tutoring company dedicated to providing top-tier educational...