Utilization Review Nurse

As our Utilization Review Nurse, you will ensure the medical necessity and appropriateness of care for all hospitalized patients, promoting fiscal responsibility and optimal patient outcomes. You will leverage specialized utilization review criteria, technologies, and tools to verify the correct level of care throughout their acute stay.

Every day you will perform meticulous clinical assessments, identify and coordinate cost-effective alternatives, and proactively support provider decision-making. You will collaborate with the healthcare team, patients, families, and both internal/external customers to achieve optimal outcomes efficiently and ethically, ensuring compliance with payer guidelines and regulatory standards.

To be successful in this role you will have strong analytical skills, persuasive communication, and a steadfast commitment to patient advocacy.  Fiscal stewardship is crucial for navigating complex clinical and financial landscapes, ensuring appropriate resource utilization.

Required

• Bachelor's degree in Nursing and 3 years of professional nursing experience in a hospital setting.
• Active Washington State Registered Nurse License.
• Experience in utilization review.
• Demonstrated ability to work collaboratively with all members of the care team (CNLs, MSWs, MDs) in conveyance of information that affects patient care.
• An understanding of variable payor rules and regulations is also required.

Preferred

• Knowledge of core insurance coverage guidelines and financial principles.
• Acute care nursing experience.

Virginia Mason Franciscan Health brings together two award winning health systems in Washington state - CHI Franciscan and Virginia Mason. As one integrated health system with the most patient access points in western Washington our team includes 18,000 staff and nearly 5,000 employed physicians and affiliated providers. At Virginia Mason Franciscan Health you will find the safest and highest quality of care provided by our expert, compassionate medical care team at 11 hospitals and nearly 300 sites throughout the greater Puget Sound region.