Utilization Review Registered Nurse - Case Management

We are seeking a highly skilled and compassionate Utilization Review Registered Nurse to join our dynamic Case Management team at Providence St. Joseph Health. In this role, you will utilize your clinical expertise and knowledge of insurance protocols to ensure that patients receive the most appropriate and cost-effective care. As a member of our team, you will play a crucial role in advocating for patients and collaborating with healthcare providers to ensure optimal outcomes. Our ideal candidate is a dedicated and detail-oriented RN with a strong background in case management and utilization review. If you are passionate about making a positive impact on patients' lives and are looking for a fulfilling career in a supportive and collaborative environment, we encourage you to apply for this exciting opportunity.

1. Conduct timely and thorough utilization reviews on patient cases to ensure appropriate and cost-effective care is being provided.
2. Utilize clinical expertise and knowledge of insurance protocols to determine appropriate level of care for patients.
3. Collaborate with healthcare providers to ensure that treatment plans align with insurance guidelines and meet the needs of the patient.
4. Advocate for patients and their families by communicating with insurance companies and healthcare providers to resolve any issues or concerns related to coverage and care.
5. Conduct ongoing assessments of patients' progress and make recommendations for changes in treatment plans as needed.
6. Maintain accurate and detailed documentation of utilization review processes and outcomes.
7. Act as a resource and provide education to healthcare providers and team members regarding insurance protocols and utilization management.
8. Stay up-to-date on changes in insurance regulations and guidelines, and implement necessary changes in utilization review processes.
9. Participate in case conferences and multidisciplinary team meetings to ensure coordinated and comprehensive care for patients.
10. Collaborate with social workers and other members of the case management team to address any barriers to discharge and ensure a smooth transition of care for patients.

According to JobzMall, the average salary range for a Utilization Review Registered Nurse - Case Management in Seattle, WA, USA is between $80,438 and $96,525 per year. However, the exact salary may vary depending on factors such as experience, qualifications, and the specific employer.

Providence Health & Services is a non-profit Catholic health care system operating multiple hospitals across 5 states, with headquarters in Renton, Washington.