The Utilization Review (UR) Nurse has a strong clinical background blended with a 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. The UR nurse is responsible for performing 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 Swedish Shared Services 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:
- Bachelor's Degree in Nursing degree (BSN) from an accredited school of nursing.
- Washington Registered Nurse License upon hire.
- 3 years of Registered nursing experience in the clinical setting.
Preferred Qualifications:
- ACM or CCM certification upon hire.
- 1 year of Case management experience.
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 improving the health and wellbeing of each patient we serve.
About UsProvidence 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.
Skills Required
- Bachelor of Science in Nursing (BSN) from an accredited school of nursing
- Washington Registered Nurse license upon hire
- Minimum 3 years of registered nursing clinical experience
- Strong clinical background and well-developed knowledge and skills in Utilization Management and medical necessity determination
- Current knowledge of commercial and government payer requirements and accreditation regulations/guidelines/criteria related to Utilization Management
- ACM or CCM certification upon hire
- 1 year of Case Management experience
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.
