RN Utilization Review at Irvine, CA. This position is Per Diem and will work Remote 8-hour, Day shifts.
Provide prospective, retrospective, and concurrent utilization reviews for our Southern CA 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 in Nursing
- Upon hire: California Registered Nurse License
- 2 years experience working in a remote UR environment or working as an acute hospital case manager.
Preferred Qualifications:
- Bachelor’s Degree in Nursing
- Master’s Degree in Nursing
- Experience working with Interqual guidelines.
- Experience in a multi-hospital and/or integrated healthcare system.
Why Join Providence?
Our ” target=”_blank” rel=”nofollow”>Mission of caring for everyone, especially the most vulnerable in our communities.
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 ” target=”_blank” rel=”nofollow”>diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.