Utilization Review RN
Full time 1 FTE
Day Shift
The Utilization Review (UR) Nurse has a strong clinical background blended with a well-developed knowledge and skills in Utilization Management (UM), medical necessity and patient status determination. This individual supports the UM program by developing and maintaining effective, efficient processes for determining the appropriate admission status based on regulatory and reimbursement requirements of commercial and government payers. The UR nurse is responsible for performing admission, concurrent and retrospective UR related reviews and functions to ensure that appropriate data is tracked, evaluated and reported. This individual actively participates in process improvement initiatives, working with multiple departments and multi-disciplinary staff. This role requires current and accurate knowledge regarding commercial and government payers as well as accreditation regulations/guidelines/criteria related to UM.
Providence caregivers are not simply valued – they’re invaluable. Join our team at Swedish Shared 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.
Caregivers are expected to honor the Mission, Values, Vision and Promise and adhere to the Code of Conduct, policies and standards of their organization.
For direct patient care roles: Performs and maintains currency of essential competencies as required by specific area of hire and populations served.
Accepts and supports the mission and values of the ministry. Supports Performance Improvement processes and patient satisfaction initiatives. Maintains a safe environment for staff, patients, and visitors. Considers individual needs in communication with patients and staff, including ethical, cultural, psychosocial, religious, and age-specific aspects, for all ages. Supports patient rights and the organization’s code of ethical behavior. Follow the principles and requirements outlined in the Commitments & Compliance Integrity Program Employee Handbook and any other organizational or departmental materials related to compliance with laws and regulatory requirements. Assesses staff ability to fulfill specified responsibilities. Demonstrates effective leadership and critical thinking skills.. Provides coverage in the absence of hospital administrative personnel and provides assistance and consultation regarding operational issues. Provides supervision of patient care services. Demonstrates the ability to collaborate with Charge Nurses/Staffing Coordinators/Directors. Demonstrates ability to utilize crisis management techniques to diffuse critical situations. Assumes responsibility for self improvement. Assist in staffing functions for Nursing Department.Required Qualifications:
Bachelor's Degree Nursing degree (BSN) from an accredited school of nursing. Upon hire: Washington Registered Nurse License 3 years Med/Surg nursing experience in the clinical setting.Preferred Qualifications:
Upon hire: ACM or CCM certification 1 year Case management experience.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 improving the health and wellbeing of each patient we serve.
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.