Utilization Review RN - Remote The RN Care Coord-Qual Med Mgmt will provide administration of medical management programs that include: prior authorization, concurrent hospital and skilled nursing review, appeals and grievance, delegation, medical policy development and medical claims audits. These programs are developed to manage medical expense, determine medically appropriate services and define clinical criteria for decision making. This includes retrospective review of claims and other data, as well as care coordination and discharge planning. Providence Health Plan caregivers are not simply valued – they’re invaluable. Join our team at Providence Health Plan Partners 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. This position works 100% remote and is open to candidates residing in: - Oregon - Washington Required Qualifications: - 5 years Clinical nursing experience. - Upon hire: Oregon Registered Nurse License and Washington State Registered Nurse License - Experience working with physicians in collaboration and management of patient care. Preferred Qualifications: - Bachelor's Degree Nursing or health care. - Utilization review, discharge planning and/or managed care experience. - Psychiatric Mental Health Nurse Certification PMH-BC Salary Range by Location: Oregon: Non-Portland Service Area: Min: $45.90, Max: $71.40 Oregon: Portland Service Area: Min: $49.34, Max: $76.59 Washington: Western: $51.43, Max: $79.84 Washington: Southwest - Olympia, Centralia & Below: Min: $49.34, Max: $76.59 Washington: Eastern: Min: $43.90, Max: $68.16 Washington: South Eastern: Min: $45.90, Max: $71.40 Why Join Providence Health Plan? 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. Accepting a new position at another facility that is part of the Providence family of organizations may change your current benefits. Changes in benefits, including paid time-off, happen for various reasons. These reasons can include changes of Legal Employer, FTE, Union, location, time-off plan policies, availability of health and welfare benefit plan offerings, and other various reasons. 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. Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts 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.

• Conduct clinical reviews for inpatient admissions and post-acute settings using evidence-based guidelines. • Serve as the primary physician reviewer for escalated or complex cases. • Engage in peer-to-peer discussions with attending physicians. • Partner with care management teams to identify utilization trends. • Ensure all decisions are documented in accordance with NCQA, CMS, and organizational standards. • Contribute expertise to initiatives focused on readmission reduction.

Discover Vanderbilt University Medical Center: Located in Nashville, Tennessee, and operating at a global crossroads of teaching, discovery, and patient care, VUMC is a community of individuals who come to work each day with the simple aim of changing the world. It is a place where your expertise will be valued, your knowledge expanded, and your abilities challenged. Vanderbilt Health is committed to an environment where everyone has the chance to thrive and where your uniqueness is sought and celebrated. It is a place where employees know they are part of something that is bigger than themselves, take exceptional pride in their work and never settle for what was good enough yesterday. Vanderbilt’s mission is to advance health and wellness through preeminent programs in patient care, education, and research. Organization: ANC - Model Office Job Summary: Provides service to patients and providers during inbound and outbound phone calls while scheduling appointments, capturing messages for the clinic staff and providers, and addressing the needs of the customer with occasional guidance. Schedules patient appointments, escalates patients' health concerns in accordance with individual division guidelines, provides connections to resources for clinical advice and guidance, and navigates complex situations while making sound effective decisions. . KEY RESPONSIBILITIES • Answers calls for multiple areas in efficient and effective manner using standard greetings for opening of call, content of call and closure of call. • Ensures accuracy in answering questions and assisting customer with requests to meet their needs. • Captures customer information and document using messaging system to clinic staff and/or providers. • Schedules appointments in electronic systems using guidelines for area/department including prioritizing patients' health problems according to their urgency, educating/advising patients and making safe, effective decisions. • Provides information to customer regarding appointment location, process steps, parking, etc. • The responsibilities listed are a general overview of the position and additional duties may be assigned. TECHNICAL CAPABILITIES • Customer Service (Fundamental Awareness): A continuing focus on the needs and requirements of customers, anticipating their needs, remaining sensitive to customers while performing services for them, responsive to customer needs. • Patient Scheduling (Fundamental Awareness): The ability to coordinate and schedule patient appointments, surgeries and other office visits with various computer systems in the hospital or clinic. • Call Center Telephone Etiquette (Fundamental Awareness): Able to handle patient or provider calls and contribute positively to the call center working environment. Demonstrates good manners, decorum and appropriate protocols. Avoids and neutralizes conflicts and handles difficult callers in a positive and professional way. • Patient Satisfaction (Fundamental Awareness): Participates in patient satisfaction related process improvement activities as well as providing high quality contact experience for the patient with every call. This position also has direct effect on ease of scheduling appointment and ease of getting clinic on the phone. Our professional administrative functions include critical supporting roles in information technology and informatics, finance, administration, legal and community affairs, human resources, communications and marketing, development, facilities, and many more. At our growing health system, we support each other and encourage excellence among all who are part of our workforce. High-achieving employees stay at Vanderbilt Health for professional growth, appreciation of benefits, and a sense of community and purpose. Core Accountabilities: * Organizational Impact: Performs clearly defines tasks and methods described in detail to achieve standardized solutions that impact own performance with regular guidance. * Problem Solving/ Complexity of work: Follows a well established process to solve routine problems where solutions are clearly prescribed. * Breadth of Knowledge: Has basic job knowledge of systems and procedures that are common to own job. * Team Interaction: Individually contributes to the team. Core Capabilities : Delivering Excellent Services : Serves Others with Compassion: Invests time to understand the problems, needs of others and how to provide excellent service. Solves Complex Problems: Seeks to understand issues, solves routine problems, and raises proper concerns in a timely manner. Offers Meaningful Advice and Support: Listens carefully to understand the issues and provides accurate information and support. Ensuring High Quality : Performs Excellent Work: Checks work quality before delivery and asks relevant questions to meet quality standards. Ensures Continuous Improvement: Shows eagerness to learn new knowledge, technologies, tools or systems and displays willingness to go above and beyond. Fulfills Safety and Regulatory Requirements: Demonstrates basic knowledge of conditions that affect safety and reports unsafe conditions to the appropriate person or department. Managing Resources Effectively: Demonstrates Accountability: Takes responsibility for completing assigned activities and thinks beyond standard approaches to provide high-quality work/service. Stewards Organizational Resources: Displays understanding of how personal actions will impact departmental resources.Makes Data Driven Decisions: Uses accurate information and good decision making to consistently achieve results on time and without error. Fostering Innovation :Generates New Ideas: Willingly proposes/accepts ideas or initiatives that will impact day-to-day operations by offering suggestions to enhance them. - Applies Technology: Absorbs new technology quickly; understands when to utilize the appropriate tools and procedures to ensure proper course of action. - Adapts to Change: Embraces changes by keeping an open mind to changing plans and incorporates change instructions into own area of work. Position Qualifications: Responsibilities: Certifications: Work Experience: Relevant Work Experience Experience Level: 1 year Education: High School Diploma or GED Vanderbilt Health is committed to fostering an environment where everyone has the chance to thrive and is committed to the principles of equal opportunity. EOE/Vets/Disabled.

Job Description Summary Managing, ensuring and improving capabilities to comply with external standards and regulations. Interprets internal and external business challenges and recommends best practices to improve products, processes or services. Stays informed of industry trends that may influence work. GE HealthCare is a leading global medical technology and digital solutions innovator. Our mission is to improve lives in the moments that matter. Unlock your ambition, turn ideas into world-changing realities, and join an organization where every voice makes a difference, and every difference builds a healthier world. Job Description Roles and Responsibilities - Executes against GEHC's Central Quality & Regulatory Audit program. This includes scheduling, preparation, execution, reporting, and follow-up activities associated with Central Quality & Regulatory Internal Audits; identification and communication of high-risk issues; reporting compliance concerns and recommended improvements to business leadership; and ensuring audit strategy is executed to current industry practices and regulatory expectations. - Supports GEHC Health / Competent Authority audits. This includes preparation, back-room management, tracking of Lessons Learned, and driving follow-up activities. - Supports GEHC Quality Management System by defining, tracking, and maintaining metrics to promote early awareness and visibility of Quality & Regulatory issues. Regularly advises management in Central Quality. - Requires specialized depth and/or breadth of expertise within a quality or regulatory discipline and ability to influence the development of strategy within own area, including participation in policy formulation. - Requires ability to lead functional teams or projects with indirect resources and medium to high risk and/or complexity. Communicates difficult concepts and influences others' options on topics. May guide others to consider a different point of view. - Impacts the team's ability to achieve service, quality, and timeliness of objectives. Work is subject to GEHC policy objectives. - Uses high level of judgment to make decisions and handle complex tasks or problems. Has ability to assess quality of information given and ask pertinent questions to stakeholders. Able to offer new solutions to problems outside of set parameters and construct and provide recommendations. Uses multiple internal and some external sources outside of own function to help arrive at a decision. - Develops self and others by promoting strong Quality & Regulatory practices, providing feedback, training, and mentorship, and collaborating with stakeholders to achieve desired results. Required Qualifications - Qualified Lead Auditor with active certification. - Master’s Degree and a minimum of 5 years’ experience in the medical device industry; or Bachelor's Degree and a minimum of 10 years’ experience in the medical device industry; or will consider a High School Diploma and a minimum of 15 years' of progressive responsibility in the medical device industry. - Minimum of 5 years’ Experience driving Global programs to resolve quality compliance issues (directly). - Experience with Medical Device QMS requirements and regulatory requirements including but not limited to FDA CFR 21 820 and ISO 13485. Desired Characteristics - Prior notified body or health authority experience a plus. - ASQ Certification (CQE, CQA, etc.) and/or Lean Certification a plus (green belt, black belt). - Design controls, design verification and validation activities. - Production and process controls. - Class III US FDA PMA Device requirements. - CAPA, complaints and risk management. - Understanding of product quality improvement using tools such as Six Sigma, DFR. - Demonstrated ability to analyze and resolve problems. - Exceptional conflict-resolution skills. - Ability to interface with top organizational leadership and internal and external customers, responding in a professional manner. - Demonstrated ability to lead programs / projects. Ability to prioritize and drive multiple programs. - Ability to energize others by building a connection with the team through personal involvement and trust, providing feedback and coaching to develop others, and accountability of actions. - Strong oral and written communication skills in English. - Integrity: Accepting and adhering to high ethical, moral, and personal values in decisions, communications, actions, and when dealing with others. - Ability to travel domestically and internationally up to 40%. We expect all employees to live and breathe our behaviors: to act with humility and build trust; lead with transparency; deliver with focus, and drive ownership –always with unyielding integrity. Our total rewards are designed to unlock your ambition by giving you the boost and flexibility you need to turn your ideas into world-changing realities. Our salary and benefits are everything you’d expect from an organization with global strength and scale, and you’ll be surrounded by career opportunities in a culture that fosters care, collaboration and support. #LI-MC2 #LI-Remote We will not sponsor individuals for employment visas, now or in the future, for this job opening. For U.S. based positions only, the pay range for this position is $142,400.00-$213,600.00 Annual. It is not typical for an individual to be hired at or near the top of the pay range and compensation decisions are dependent on the facts and circumstances of each case. The specific compensation offered to a candidate may be influenced by a variety of factors including skills, qualifications, experience and location. In addition, this position may also be eligible to earn performance based incentive compensation, which may include cash bonus(es) and/or long term incentives (LTI). GE HealthCare offers a competitive benefits package, including not but limited to medical, dental, vision, paid time off, a 401(k) plan with employee and company contribution opportunities, life, disability, and accident insurance, and tuition reimbursement. Additional Information GE HealthCare offers a great work environment, professional development, challenging careers, and competitive compensation. GE HealthCare is an Equal Opportunity Employer. Employment decisions are made without regard to race, color, religion, national or ethnic origin, sex, sexual orientation, gender identity or expression, age, disability, protected veteran status or other characteristics protected by law. GE HealthCare will only employ those who are legally authorized to work in the United States for this opening. Any offer of employment is conditioned upon the successful completion of a drug screen (as applicable). While GE HealthCare does not currently require U.S. employees to be vaccinated against COVID-19, some GE HealthCare customers have vaccination mandates that may apply to certain GE HealthCare employees. Relocation Assistance Provided: No Application Deadline: March 12, 2026