Registered Nurse - Utilization Review
Trinity Health · Centralia, WA
Job description
Job Title This is a remote position but will need onsite training in Mishawaka Indiana. Shift: PRN/Days - 8 hr shift Considering local candidates only!!! Why Choose Saint Joseph Health System? At Saint Joseph Health System, our values guide every decision we make. Even when challenges arise, we remain committed to our mission: caring for every person who needs us. We invest in our people, our technology, and our capabilities so we can continue delivering exceptional, compassionate care to our communities. What We Offer • Tuition reimbursement for all full-time and part-time colleagues starting on day one • Comprehensive benefits beginning day one (Medical, Dental, Vision, PTO, Life Insurance, STD/LTD, and more) • Retirement savings plan with employer match • Generous paid time off program plus 7 paid holidays • No mandatory overtime • Employee referral incentive program • Access to state-of-the-art equipment, unlimited CEUs, and a supportive team-focused work environment What You Will Do • Conduct clinical reviews of patient records to evaluate medical necessity, appropriateness of admission, treatment, and length of stay across all payor types • Apply standardized criteria, regulatory guidelines, and insurance requirements to support reimbursement and compliance • Collaborate with physicians, nursing staff, and interdisciplinary teams to ensure appropriate resource utilization and care planning • Review admissions and ongoing patient cases; recommend or escalate cases that do not meet criteria to leadership or the Utilization Review Committee • Facilitate timely discharges, transfers, and recertifications when level of care is no longer appropriate • Partner with Medicare, Medicaid, and private insurers to ensure accurate documentation and reimbursement processes • Respond to denials and authorization changes by reviewing medical records and communicating outcomes to care teams and patients • Identify trends and utilization concerns; contribute to performance improvement and quality initiatives • Maintain accurate records, compile reports, and support utilization review program operations • Provide education to clinical staff on documentation requirements, coverage guidelines, and utilization processes • Support compliance with all regulatory, accreditation, and organizational standards • Participate in committee meetings and assist in development of utilization review plans and processes What You Will Need • Graduate of an accredited Registered Nurse (RN) program; Bachelor's Degree in Nursing preferred • Active RN license (state-specific requirement applies) • Minimum of 2 years of acute care nursing experience • Prior utilization review, case management, or payer review experience preferred • Strong knowledge of Medicare, Medicaid, and commercial insurance guidelines • Solid understanding of clinical care practices, diagnoses, treatment modalities, and hospital operations • Excellent communication skills with the ability to collaborate effectively across teams • Strong analytical and critical thinking skills to assess clinical appropriateness and compliance • Proficiency in computer systems and Microsoft Office applications • Ability to manage multiple priorities in a fast-paced healthcare environment • Flexibility to adapt to changing schedules, workflows, and departmental needs Our Commitment Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.
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Licensed Psychiatric Mental Health Nurse Practitioner
Headway · Centralia, WA
" Licensed Psychiatric Nurse Practitioner Wage: Up to $206.36/hour Did you know that you can build a flexible private practice on your terms as a psychiatric nurse practitioner? Whether you want to see patients alongside a full-time job or grow a full-time practice, Headway makes it easy to accept insurance, boost your earnings, and focus on care - without the administrative burden. It's all on one free-to-use platform, no commitment required. About the role This position is for licensed psychiatric nurse practitioners looking to start or grow their private practice. Headway provides the tools, resources, and support to help you navigate insurance, streamline operations, and let you focus on what matters most - your patients. About you • You're a fully licensed psychiatric nurse practitioner with your DEA or CDS number, ANCC or AANP board certification, a valid NPI number and malpractice insurance. • You're looking to start or expand your private practice while maintaining control over your schedule, client load, and work environment. Why partner with Headway? As an independent provider with Headway, you'll gain access to: • Hassle-free insurance credentialing: Get credentialed for free in multiple states within as little as 30 days. • Increased earnings: Secure competitive rates with top insurance plans through our nationwide network. • Predictable bi-weekly payments: Receive reliable payouts directly from Headway. • Built-in EHR tools: Access real-time scheduling, secure client messaging, documentation templates, assessments, and more. • Compliance & audit support: Stay up-to-date with insurance requirements and industry regulations. • Free continuing education: Earn CEUs and expand your expertise through Headway Academy. How Headway supports your patients • Increased access: Headway makes it easier for your clients to get the care they need at a price they can afford through insurance. • Instant verification: Clients can easily check their insurance status and get the care they need without disruption. Important Notes • This is a 1099 independent contractor role. You'll have full autonomy over your practice, including setting your hours and managing your caseload. • At this time, Headway can't support mental health professionals that aren't fully licensed. If your application was rejected for incomplete licensure, you're welcome to reapply once you have a valid license. About Headway We make it easy for mental health providers to take insurance by credentialing you with the nation's largest networks, handling billing and admin paperwork, and helping you earn more stable income with higher rates. With Headway, you can finally focus on what matters most: providing life-changing care. We'll take care of the rest.
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We are seeking a compassionate nurse (LPN) to join our growing team! In this role, you will provide critical after-hours support, triaging hospice patients and family needs over the phone wit professionalism and empathy. You will help ensure timely interventions and coordination of care for patients receiving hospice services. Built around a mission to improve the lives of nurses and patients, IntellaTriage has been providing after-hours nurse triage for hospice and home health providers since 2008. Utilizing best-in-class technology, IntellaTriage provides round-the-clock direct access to licensed, registered nurses using client-customized protocols for patient-centered, compassionate care. We are growing rapidly and excited to support our clients' nursing staff in the field by leveraging our remote team of nurses to manage after-hours care delivery. Our triage nurses become an extension of our clients' care team, and they trust us to support them and their patients during their non-core hours. Learn more at www.intellatriage.com. Why Join Us • Base pay at $19 an hour with multiple opportunities to increase the hourly rate with a potential to earn up to $22 an hour within your first 6 months of hire • 3 weeks of paid remote training • Supportive clinical team • Work from home allows you to create a comfortable and personalized workspace • Shorter shifts that provide a better work-life balance and reduce potential for burnout • 4 weekday shifts Monday-Friday 6:30a-4p CST, 1 set scheduled off day • Working remotely gives you more time to spend with those you love! What do our nurses say? When asked what inspires her, 2024 IntellaTriage Nurse of the Year shared: “Helping people. That's it. And knowing this team has your back—that makes all the difference. People say it takes a special kind of person to do hospice, and I think that's true. You're walking with people and their families through one of the most sacred times in life. It's an honor to support them and guide them through that journey. I'm so grateful to have been chosen for this award.” At IntellaTriage we recognize nurses who go above and beyond to make a meaningful impact on patients' lives. This years' honoree exemplifies what it means to lead with compassion, skill, and dedication. Read more about being a nurse at IntellaTriage, and the reward: Requirements • Active multistate Licensed Practical Nurse (LPN license • Hospice, palliative, or end-of-life care is strongly preferred • Must be comfortable with technology and electronic medical records (EMR) utilized for documentation of calls • Ability and comfort with typing documentation and notes in a fast-paced environment • Must be able to handle stress and multitask when receiving calls (minimum of 5 calls per hour on weekdays, and up to 8 per hour on weekends) • Strong communication and critical thinking skills • Ability to work independently in a remote environment • This is a remote position that requires consistent attendance, active communication, and reliable internet connectivity during all scheduled shifts to support timely patient care coordination Key responsibilities • Provide telephone triage for hospice patients and families • Assess patient conditions and determine appropriate next steps • Collaborate with on-call teams to coordinate care and resources • Accurately document all communications and interventions • Maintain a calm and professional demeanor while handling urgent calls. Benefits All Remote Hospice Triage LPNs, once trained to their originally assigned team are paid $19 per hour. There are multiple opportunities to increase the hourly rate with the potential to earn up to $22 an hour within your fist 6 months of hire. All nurses are eligible for a $2 shift differential for overnights and a $2 shift differential for weekends (Friday evening, Saturday & Sunday). All part-time and full-time nurses accumulate PTO, based on the number of hours worked (per year). All part-time and full-time nurses are eligible to participate in our 401(k) plan. Full-time nurses may also participate in medical, dental, vision, and/or supplemental insurances.