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Providence Health & Services RN Care Coordinator Utilization Management in Everett, Washington

Description:

Providence is calling for a Registered Nurse Care Coordinator to support the Utilization Management team focusing on clinical reviews and denials (1.0 FTE, Days) to Providence Health & Services in Everett, WA.

We are seeking a Registered Nurse to support the Utilization Management team 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.

This is a FULL TIME - Day Shift position working Monday - Friday, working weekends on a rotational basis.

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.

Qualifications:

Required qualifications for this position include:

  • Bachelor's Degree in Nursing (BSN) or must be willing to obtain a BSN or higher within 5 years of hire.

  • Experience as an RN in an acute care setting in the last 5 years or recent utilization management experience.

  • Current RN license in Washington State.

Preferred qualifications for this position include:

  • Experience with Interqual or Milliman Criteria.

  • Care management, medical insurance or discharge planning experience.

  • UM certification.

  • Case management certification.

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.

We offer a full comprehensive range of benefits - see our website for details

http://www.providenceiscalling.jobs/rewards-benefits/

Our Mission

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.

About Us

Providence Health & Services is a not-for-profit Catholic network of hospitals, care centers, health plans, physicians, clinics, home health care and services guided by a Mission of caring the Sisters of Providence began over 160 years ago. 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.

Schedule: Full-time

Shift: Day

Job Category: Nursing - Other

Location: Washington-Everett

Req ID: 231879

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