Providence RN Care Coordinator Utilization Management *1.0 FTE, Day Shift* in Everett, Washington
Providence is calling a Registered Nurse Care Coordinator, Utilization Management (1.0 FTE, DAY SHIFT) to the Utilization Management at Providence Regional Medical Center Everett in Everett, WA.
APPLY TODAY! Applicants that meet qualifications will receive a text message with some additional questions from our Modern Hire system.
We are seeking a Care Coordinator Utilization Management to oversee utilization management and review of patients care delivery while in the hospital and provide clinical reviews and denial appeals where appropriate either during admission or post discharge.
In this position you will:
Review the electronic medical records to perform admission screens on new admits utilizing Interqual criteria to determine medical appropriateness of the hospital admission and to address appropriate patient class determination.
Perform continued stay reviews on current patients and communicate clinical information to payers in a timely manner such that the patient’s hospital days are authorized.
Manage concurrent denials and facilitate peer to peer physician reviews.
Demonstrate age specific patient care considerations for the population served.
Coordinate with discharge planning through active organization and monitoring of the patient care process to provide continuity of care cost effectiveness.
Required qualifications for this position include:
Nursing Degree/ diploma upon hire
Bachelors of Nursing (BSN) or higher required within five (5) years of hire
Any previously agreed upon effective date for obtaining a Bachelor’s degree in nursing between individual and facility will remain in effect.
Any collective bargaining contract with specific time frames for obtaining a Bachelor’s degree in nursing will supersede the above point and will remain in effect.
Exceptions will be considered on a case-by-case basis at each facility by the most senior administrative nursing leader in consultation with the Human Resources leader
Current RN license in Washington State
Experience as an RN in an acute care setting in the last 5 years or recent utilization management experience
Preferred qualifications for this position include:
Utilization Management certification
Case Management certification
Utilization review or case management experience
Experience with Interqual or Milliman Criteria
Care management, medical insurance or discharge planning experience
About the hospital you will serve:
Providence Regional Medical Center Everett in Everett, WA is the state’s most award-winning hospital for medical care; having received the HealthGrades Distinguished Hospital Award for Clinical Excellence four years in a row. Our new state-of-the-art 12 story hospital tower and the implementation of an electronic medical records system will significantly enhance our patient’s experience throughout the continuum of care.
The hospital is located in Snohomish County on the Sound and close to the mountains, so outdoor activities such as snow skiing, kayaking, and golfing are at your doorstep. The communities in Snohomish have all the comforts and appeal of small towns, with historical districts, beautiful homes, interesting boutiques, and unique restaurants, yet the city life of Seattle and Bellevue are just 30 minutes south, while the cosmopolitan city of Vancouver, BC lies only 2 hours north.
For information on our comprehensive range of benefits, visit:
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate 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.
Job Category: Case Management
Req ID: 276058