Top 12 Rn utilization review Jobs in Everett, Wa

Care Review Clinician (RN)
Molina Healthcare —Bothell, WA
- $26.41 - $59.21 an hour
- Full-time
- RN License
- Mid-level
- Critical & Intensive Care
- Health insurance
20h
Care Manager RN - 0.6 FTE- Day
Providence —Everett, WA
- $47.73 - $89.59 an hour
- Part-time
- Acute care
- Nursing
- RN License
- Paid parental leave
- Paid holidays
Care Manager RN - 1.0 FTE Day
Providence —Everett, WA
- $47.73 - $89.59 an hour
- Full-time
- Acute care
- Nursing
- RN License
- Paid parental leave
- Paid holidays
Registered Nurse (RN) - Part-Time Swing
Northpoint Recovery Holdings, LLC —Edmonds, WA
- $42 - $50 an hour
- Part-time
- CPR Certification
- Nursing
- Vital signs
- 401(k) matching
- Referral program
Quick Apply
Resident Nurse
Skagit Regional Health —Arlington, WA
- $43.68 - $82.65 an hour
- Overtime
- Acute care
- Nursing
- RN License
- Disability insurance
- Health insurance
1d
Care Manager RN ED - Night
Providence —Everett, WA
- $47.73 - $89.59 an hour
- Full-time
- Acute care
- Nursing
- RN License
- Paid parental leave
- Paid holidays
Staff Nurse
Skagit Regional Health —Arlington, WA
- $42.10 - $79.66 an hour
- Overtime
- Nursing
- RN License
- Mid-level
- Disability insurance
- Health insurance
Manager, Transitions of Care
Overlake Medical Center and Clinics —Bellevue, WA
- $111,155 - $177,840 a year
- Day shift
- Nursing
- RN License
- Hospital
- Tuition reimbursement
- Employee assistance program
9d

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rn utilization review jobs near everett, wa

Care Review Clinician (RN)

Molina Healthcare -
Bothell, WA

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Job Details

Full-time
$26.41 - $59.21 an hour
20 hours ago

Benefits

Health insurance

Qualifications

Inpatient experience
RN License
Managed care organization experience
Acute care facility experience
Productivity software

Full Job Description

JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care.

Essential Job Duties

Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines.
Analyzes clinical service requests from members or providers against evidence based clinical guidelines.
Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.
Conducts reviews to determine prior authorization/financial responsibility for Molina and its members.
Processes requests within required timelines.
Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner.
Requests additional information from members or providers as needed.
Makes appropriate referrals to other clinical programs.
Collaborates with multidisciplinary teams to promote the Molina care model.
Adheres to utilization management (UM) policies and procedures.

Required Qualifications

At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience.
Registered Nurse (RN). License must be active and unrestricted in state of practice.
Ability to prioritize and manage multiple deadlines.
Excellent organizational, problem-solving and critical-thinking skills.
Strong written and verbal communication skills.
Microsoft Office suite/applicable software program(s) proficiency.

Preferred Qualifications

Certified Professional in Healthcare Management (CPHM).
Recent hospital experience in an intensive care unit (ICU) or emergency room.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/VPay Range: $26.41 - $59.21 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

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rn utilization review jobs in everett, wa

Care Review Clinician (RN)

Care Manager RN - 0.6 FTE- Day

Care Manager RN - 1.0 FTE Day

Registered Nurse (RN) - Part-Time Swing

Resident Nurse

Care Manager RN ED - Night

Staff Nurse

Manager, Transitions of Care

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