Job Summary
The Utilization Review RN plays a crucial role in managing and coordinating care throughout the healthcare system, aiming to achieve high-quality and economically viable outcomes for members. This position focuses on conducting utilization reviews to promote patient-centered care while aligning with the organization’s mission and standards.
Responsibilities
- Conduct thorough utilization reviews to facilitate efficient patient care.
- Coordinate healthcare services across different levels to enhance patient outcomes.
- Ensure compliance with healthcare standards and the organization’s mission.
- Monitor and evaluate patient care plans and their effectiveness.
Qualifications
- Graduation from an accredited nursing program.
- Possession of a valid Registered Nurse License in California.
- Minimum of 3 years of experience in utilization review or case management.
- At least 3 years of clinical experience in a hospital or medical office environment.
- Familiarity with Milliman criteria is essential.
Providence provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
