RN Utilization Management Reviewer (Per Diem) - Remote (OR, WA or AK)

PeaceHealth, based in Vancouver, Washington, is a not-for-profit health system offering care to communities in Washington, Oregon, and Alaska. PeaceHealth has approximately 17,000 Caregivers, a multi-specialty medical group practice with more than 1,200 physicians and providers and ten medical centers serving both urban and rural communities throughout the Northwest. At the heart of our Mission, Values, and Vision is our responsibility to our patients, their loved ones and our communities. For over a century, PeaceHealth has been committed to Exceptional Medicine and Compassionate Care. Our founding Sisters, known for their activist and reformist ways, committed to a mission of social justice and healing for all. This vision continues to resonate in all that we do, including the relentless pursuit of continually improving our health care services and care. Today, our heritage and clinical excellence are carried on by Caregivers like you. Are you ready to join our journey? Apply to join our growing team! PeaceHealth is dedicated to EEO and Affirmative Action for all protected groups, including veterans and the disabled.

Join PeaceHealth in advancing compassionate, mission-driven care from wherever you are. PeaceHealth is looking for a skilled and motivated Registered Nurse Utilization Management (UM) Reviewer to join our dedicated team in a Per Diem, Day Shift role. If you enjoy analytical work and are energized by helping ensure patients receive the right care at the right time, this remote opportunity may be the perfect next step in your nursing career. Coverage needed could include weekdays, weekends and holidays. As a Utilization Management Reviewer at PeaceHealth, you will play a key part in supporting safe, high-quality, and efficient patient care across our healthcare system. This position centers on concurrent and retrospective UM reviews, leveraging clinical expertise, payer policy knowledge, and technology tools to guide patient status determinations and promote appropriate utilization of hospital resources. You’ll work fully remote*, with PeaceHealth-provided computer equipment—empowered by a collaborative team, supportive leadership, and a strong organizational commitment to diversity, cultural humility, and caregiver well-being. *Must reside in Washington, Oregon, or Alaska. PeaceHealth will provide the caregiver with necessary computer equipment. It is the responsibility of the caregiver to provide Internet access.

Coordinate accurate patient status identification and documentation Ensure correct admission status and reimbursement through certification and clinical review Gather additional clinical documentation to validate treatment plans and level of care Collaborate closely with physicians, clinicians, and multidisciplinary teams Apply UM criteria using the Xsolis Dragonfly™ platform and PeaceHealth Care Level Score tools Conduct pre-admission status reviews in the ED, patient access areas, and elective settings Communicate with third-party payers regarding medical necessity and discharge progress Support denial and appeal processes; refer cases for physician advisor review when appropriate Participate in UM Committee work, quality initiatives, and performance improvement Identify DRGs with complications/comorbidities and recommend documentation improvements Promote responsible hospital resource utilization, length-of-stay optimization, and care efficiency Perform other duties as needed to support UM and organizational goals