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Utilization Management Nurse - First Hill

Providence Health & Services
United States, Washington, Seattle
August 07, 2022


Utilization Management Nurse - Case Management Department at Swedish First Hill


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.

Applicants that meet qualifications will receive a text message with some additional questions from our partner Modern Hire.

Required qualifications:

  • Nursing degree (BSN) from an accredited school of nursing
  • Current Washington State Nursing license
  • Three (3) years Registered Nursing experience in the clinical setting

Preferred qualifications:

  • ACM or CCM certification
  • One (1) year case management experience

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 Swedish Shared Services.

Swedish is the largest, most comprehensive, nonprofit health provider in the Greater Seattle area. It is comprised of five hospital campuses (First Hill, Cherry Hill, Ballard, Edmonds and Issaquah); emergency rooms and specialty centers in Redmond (East King County) and the Mill Creek area in Everett; and Swedish Medical Group, , a network of more than 128 primary care and specialty care locations throughout the Puget Sound area.

Each campus has a local operations leadership team, supported by centrally located and led corporate services, such as Human Resources, Financial and Information Services.

We offer a full comprehensive range of benefits - see our website for details - https://caregiver.ehr.com .

About Providence

At Providence, our strength lies in Our Promise of "Know me, care for me, ease my way." Working at our family of organizations means that regardless of your role, we'll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

Requsition ID: P366673

Company: Swedish Jobs

Job Category: Health Information Management

Job Function: Revenue Cycle

Schedule: Full time

Shift: Day

Career Track: Nursing

Department: 3900 SS Case Management

Address: WA Seattle 1730 Minor Ave

Swedish Health Services 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.