RN Utilization Review - Full-time Day- REMOTE

Position Overview

Join our team as an RN Utilization Review at Providence California Regional Services in Irvine, CA.Location: CA Irvine 15480 Laguna Canyon Rd.Schedule: Full-time, Remote, 8-hour Day shifts.Compensation: $56.44 - $87.63 per hour base; additional compensation such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives or bonus opportunities may apply.
In this role, you will provide prospective, retrospective, and concurrent utilization reviews for our Southern CA ministries while ensuring clinical reviews and medical record assessments meet health plan requirements. Join a team where your clinical expertise and commitment to patient-focused care make you an invaluable part of our culture.

Key Responsibilities

• Responsibilities: Provide prospective, retrospective, and concurrent utilization reviews for our Southern CA ministries.
• Responsibilities: Conduct clinical reviews and examine medical records daily during admission for all payers as required by the health plans.
• Responsibilities: Manage a diverse workload in a fast-paced, regulatory environment while demonstrating excellent negotiation, communication, problem-solving, and decision-making skills.

Required Qualifications

• Education: Associate's Degree Nursing.
• Requirements: Must obtain a California Registered Nurse License upon hire.
• Experience Required: 2 years of experience working in a remote utilization review environment or as an acute hospital case manager.

Preferred Qualifications

• Education: Bachelor's Degree Nursing.
• Education: Master's Degree Nursing.
• Qualifications: Experience working with Interqual guidelines.
• Qualifications: Experience in a multi-hospital and/or integrated healthcare system.

Benefits & Perks

• Benefits: Comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care (medical, dental, vision), life and disability insurance, and paid time off including parental leave, vacations, and holidays. Additional voluntary benefits and well-being resources are also offered. For more details, please visit providence.jobs/benefits.