Providence Health & Services RN Utilization Review Coordinator in Portland, Oregon
Providence is calling a RN Utilization Review Coordinator at Providence Saint Vincent Medical Center in Portland, OR. This is a full-time (1.0 FTE), day shift position.
Apply today! Applicants that meet qualifications will receive a text message with some additional questions from our Modern Hire system.
We are seeking a RN Utilization Review Coordinator that will support the care of the patient through assessment, planning, implementation and evaluation of appropriate services and resources to maximize optimum outcomes. This position works collaboratively with the multiple disciplines, both internal and external to the organization, in effecting quality and cost-effective management of the patient care along the continuum.
In this position you will have the following responsibilities:
Apply concepts of the nursing process, such as identification of disease, facilitation of healing, health promotion, illness prevention and patient care delivery to each task, clinical review and or quality improvement project
Review all Medicare and Medicaid patients daily for medical necessity using the Interqual criteria
Evaluate and refer cases for secondary medical review as appropriate
Remain current on CMS utilization requirements to ensure compliance
Collaborate with MDs to ensure all the documented elements for inpatient status are present, determine if appropriate timing to change patient class and facilitate the entering of correct orders
Document review, appropriate criteria and results in EPIC
Deliver and follow up on Code Condition 44s when necessary: informs the patient of correct status
Complete family documentation in EPIC and follows the Do Not Bill Protocol
Evaluate Medicare surgical patients for required inpatient procedures. Includes comparing the procedure against Pre-operative CPT codes
Has a working knowledge of the commercial payer’s contracts and requirements. Reviews and evaluates commercial cases for medical necessity and appropriate patient class
Work on denial management and reviews as assigned
Work with commercial payers as requested to provide appropriate clinical information (uses right fax or telephonic)
Document in EPIC. Including initial contact and authorization. Utilizes two work queues to manage reviews and authorization
Demonstrate understanding and utilization of tones, tools, and behaviors that promote patient safety in a highly reliable organization
Required qualifications for this position includes:
Bachelor's Degree in Nursing
Current, unencumbered Oregon state RN license
Five (5) years of clinical experience in an acute adult medical/surgical care setting, -OR- Current Utilization Review or Case Management experience
Demonstrated clinical expertise and experience related to a wide variety of patient populations and care delivery models.
Excellent written and verbal communication skills
Preferred qualifications for this position include:
Knowledge of Utilization Review strongly
Familiarity with insurance payors
About Providence in Oregon
As the largest healthcare system and largest private employer in Oregon, Providence offers exceptional work environments and unparalleled career opportunities.
The Providence Experience begins each time our patients or their families have an encounter with a Providence team member and continues throughout their visit or stay. Whether you provide direct or indirect patient care, we want our patients to feel that they are in a welcoming place where they can be comfortable and free from anxiety. Our employees create the Providence Experience through simple, caring behaviors such as acknowledging and welcoming each visitor, introducing ourselves and Providence, addressing people by name, providing the duration of estimated wait times and updating frequently if timelines change, explaining situations in a way that puts patients at ease, carefully listening to their concerns, and always thanking people for trusting Providence for their healthcare needs. At Providence, our quality vision is simple,
"Providence will provide the best care and service to every person, every time."
Providence is consistently ranked among the top 100 companies to work for in Oregon. It is also home to two of our award-winning Magnet medical centers. Providence hospitals and clinics are located in numerous areas, ranging from the Columbia Gorge to the wine country to sunny southern Oregon to charming coastal communities to the urban setting of Portland. If you want a vibrant lifestyle while working with a team highly committed to the art of healing, choose from our many options in Oregon.
We offer comprehensive, best-in-class benefits to our caregivers. For more information, 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: 314657