Providence Health & Services Registered Nurse Care Coordinator Utilization Management in Everett, Washington
Providence is calling for a Full Time Registered Nurse Care Coordinator to support Utilization Management at Providence Health & Services in Everett, WA . We are seeking a compassionate and caring RN Care Coordinator 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:
Oversee utilization management and review of patients care delivery while in the hospital
Utilize review processes for payers using medical review criteria
Understand of Discharge planning processes
Knowledge of Medicare and Medicaid rules
Provide insurance payer rules
Clinical application of anatomy & physiology
Knowledge regarding Best Practices & Quality standards for delivery of medical and surgical care
Provide education and leadership to physicians, nurses, discharge planners and utilization review specialists on a variety of issues around utilization and quality of care
Maintain patient and employer confidentiality
Required qualifications for this position include:
Bachelor’s of Science Degree in Nursing (BSN)
Experience as an RN in a acute care setting within the last 5 years OR recent Utilization Management (UM)experience
Current Registered Nurse (RN) license in Washington State
Preferred qualifications for this position include:
Utilization review or case management experience
Experience with Interqual or Milliman Criteria
Care Management, medical insurance or discharge planning
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
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 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.
Job Category: Case Management
Req ID: 182464