The Utilization Review (UR) Nurse has a strong clinical background blended with well-developed knowledge and skills in Utilization Management (UM), medical necessity and patient status determination. This individual supports the UM program by developing and maintaining effective, efficient processes for determining the appropriate admission status based on regulatory and reimbursement requirements of commercial and government payers. Utilizes appropriate criteria and interprets the implications of clinical status and the medical treatment plan with current federal regulations/guidelines thereby expediting the billing process, payment and preventing governmental sanction. The UR nurse is responsible for performing comprehensive admission, concurrent and retrospective UR related reviews and functions to ensure that appropriate data is tracked, evaluated and reported. This individual actively participates in process improvement initiatives, working with multiple departments and multi-disciplinary staff. This role requires current and accurate knowledge regarding commercial and government payers as well as accreditation regulations/guidelines/criteria related to UM.
Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence St. Peter Hospital and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.
Required Qualifications:
- Upon hire: Washington Registered Nurse License.
- 3 years of Nursing experience.
Preferred Qualifications:
- Bachelor's Degree in Nursing or
- Associate's Degree in Nursing.
- 3 years of experience in Utilization Review, Care Management, Quality Management, and/or Discharge planning.
Why Join Providence?
Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.
About UsOur award-winning and comprehensive medical centers are known for outstanding programs in cancer, cardiology, neurosciences, orthopedics, women's services, emergency and trauma care, pediatrics and neonatal intensive care. Our not-for-profit network also provides a full spectrum of care with leading-edge diagnostics and treatment, outpatient health centers, physician groups and clinics, numerous outreach programs, and hospice and home care.
Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment 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. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.
For any concerns with this posting relating to the posting requirements in RCW 49.58.110(1), please click here where you can access an email link to submit your concern.
Skills Required
- Washington Registered Nurse License
- 3 years of nursing experience
- Strong clinical background with knowledge and skills in Utilization Management and medical necessity determination
- Current knowledge of commercial and government payer regulations and accreditation guidelines related to Utilization Management
- Bachelor's Degree in Nursing or Associate's Degree in Nursing
- 3 years of experience in Utilization Review, Care Management, Quality Management, and/or Discharge Planning
Providence Health & Services Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Providence Health & Services and has not been reviewed or approved by Providence Health & Services.
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Healthcare Strength — Coverage spans medical, dental, and vision, with robust mental health support including up to 25 free therapy sessions and a well‑being platform. Additional resources like caregiver assistance and plan assistance can bolster access and overall health support depending on location and eligibility.
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Retirement Support — A 401(k) with employer match and an additional discretionary contribution, plus a student‑debt retirement savings match, provide meaningful long‑term savings support. Planning tools and Public Service Loan Forgiveness eligibility further strengthen the financial security package.
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Parental & Family Support — Back‑up child and elder care through Bright Horizons and paid parental leave offer practical support for caregiving needs. Relocation assistance and other family‑oriented resources complement the core benefits where available.
Providence Health & Services Insights
What We Do
At Providence, our strength begins with understanding. We take time to see, hear and value everyone who walks through our doors—patient or caregiver, family support person or volunteer. Working with us means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others.
