Utilization Review Specialist

The Quality Management Reviewer assesses all hospital scheduled procedures and applies guidelines as established by the hospital and outside payer agencies to facilitate payment and appropriate use of hospital resources. The position is responsible for patient pre-certification according to departmental and interdepartmental policies and procedures while adhering to the patient focused admission process. The Quality Management Reviewer demonstrates job related skills in a safe, appropriate, effective and timely manner. Promotes a safe environment of care, to reduce risks and maintain safety in the work area by observing, reporting and responding to safety issues.

Providence caregivers are not simply valued  theyre invaluable. Join our team at Providence St. Patrick Hospital 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:

• 3 years of experience in a clinical setting

Preferred Qualifications:

• Associate's Degree in clinical healthcare or business field is preferred
• Bachelor's Degree in clinical healthcare or business field is preferred
• Registered Health Information Technician (RHIT) - American Health Information Management Association upon hire.
• Utilization 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 caring for everyone, especially the most vulnerable in our communities.

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.

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits.

Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.