Utilization Review RN - Remote

About the Role

The RN Care Coord-Qual Med Mgmt will administer medical management programs, including prior authorization, concurrent hospital and skilled nursing review, appeals and grievance, delegation, medical policy development, and medical claims audits. These programs aim to manage medical expenses, determine medically appropriate services, and define clinical criteria for decision-making. Responsibilities also include retrospective claims and data review, care coordination, and discharge planning.

Providence Health Plan caregivers are not simply valued — they're invaluable. Join our team at Providence Health Plan Partners 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.

Work Environment

This position works 100% remote and is open to candidates residing in:

• Oregon
• Washington

Required Qualifications

• 5 years of clinical nursing experience.
• Upon hire: Oregon Registered Nurse License and Washington State Registered Nurse License.
• Experience working with physicians in collaboration and management of patient care.

Preferred Qualifications

• Bachelor's Degree in Nursing or health care.
• Utilization review, discharge planning, and/or managed care experience.
• Psychiatric Mental Health Nurse Certification PMH-BC.

Salary Range by Location

Oregon:

• Non-Portland Service Area: Min: $45.90, Max: $71.40
• Portland Service Area: Min: $49.34, Max: $76.59

Washington:

• Western: Min: $51.43, Max: $79.84
• Southwest - Olympia, Centralia & Below: Min: $49.34, Max: $76.59
• Eastern: Min: $43.90, Max: $68.16
• South Eastern: Min: $45.90, Max: $71.40

Why Join Providence Health Plan?

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.

Please note: Accepting a new position at another facility that is part of the Providence family of organizations may change your current benefits. Changes in benefits, including paid time off, happen for various reasons. These reasons can include changes of Legal Employer, FTE, Union, location, time-off plan policies, availability of health and welfare benefit plan offerings, and other various reasons.