Providence is calling an RN- Medical Appeals to our Care Management Department at Providence Health & Services in Olympia, WA.
We are seeking a Registered Nurse- Utilization Review Appeals to be responsible for facilitating the local appeal process for medical and experimental denials, performing medical reviews/ audits, analyze audit results and report's findings to promote and improve processes, promoting coordination of care, achievement of consistent and/or expected clinical conditions, promoting patient advocacy, and efficient resource management.
This is a full-time, 8-hour, dayshift position. This position is exempt from overtime.
In this position you will:
- Facilitate the local appeal process for medical and experimental denials.
- Perform medical reviews/ audits, analyze audit results and reports findings to promote and improve processes.
- Demonstrate expertise in the application of the nursing process.
- Assess patients for care management services after a referral has been made based on the Admission screening and referrals for potential patient issues.
- Appropriately identify actual and potential care issues.
- Develop and manage a coordinated plan of care to meet patient and/or family needs.
- Assure that patients are placed on appropriate clinical pathway and protocols, individualizes patient care needs through consultation with the multidisciplinary team.
- Monitor the patient/family progress towards achieving optimal functional status.
Required qualifications for this position include:
- An Associate Degree in Nursing.
- Bachelors of Nursing (BSN) or higher required within three (3) years of hire or twenty (20) years of RN experience.
- Three years of RN experience in Utilization Review, Home Health, Quality Management and/or Discharge Planning.
Preferred qualifications for this position include:
- Bachelor's Degree in Nursing.
- Master's degree in health care or business administration.
- Experience in hospital and/ or integrated healthcare system.
- Familiarity with Revenue Cycle processes.
About the hospital you will serve.
Providence St. Peter Hospital is a 390-bed, not-for-profit regional teaching hospital located in Olympia, WA. St. Peter offers comprehensive rehabilitation, medical, surgical and behavioral health services. We have been ranked as one of the top 100 hospitals and as one of 10 premier healthcare employers in the nation and have recently achieved the coveted Magnet® recognition from the American Nurses Credentialing Center®. Our hospital rests on a 173-acre campus, much of which includes natural forest and preserved wetlands that maintain a healing environment for patients and staff.
We offer a full comprehensive range of benefits - see our website for details
As people of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service.
Providence Health & Services is the third largest not-for-profit health system in the United States. Providence employs more than 82,000 caregivers (employees) across a five-state area; AK, WA, MT, OR, and CA. Our facilities include 34 hospitals, 600 physician clinics, senior services, supportive housing and other health and educational services. 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: 141289