Utilization Review; RN - Per Diem

Company Overview

Company Description KVH is an integrated healthcare delivery system that includes 24-hour emergency care, inpatient, and outpatient hospital services through KVH Hospital. Clinics and services include family medicine, internal medicine, a geriatric nurse practitioner program, home health and hospice, physical therapy, orthopedics, general surgery, pediatrics, women’s health, and urgent care. KVH emphasizes employee care with health benefits and continuing education programs.

For more details about the comprehensive benefits package, visit the KVH website.

The Utilization Review (UR) RN evaluates the medical necessity, appropriateness, and efficiency of healthcare services using MCG criteria, ensuring compliance with CMS regulations and payer requirements. This role facilitates timely insurance pre-authorizations, confirms medical necessity, and helps prevent avoidable denials. The UR RN works closely with clinical teams, case management, and payers to support safe, efficient care transitions and optimize reimbursement.

The UR RN collaborates with the Revenue Cycle Director and finance teams to investigate denials, inappropriate admission order status, avoidable revenue loss, and other financial risks. Responsibilities include monitoring length of stay and avoidable days, and reporting trends and findings to the Utilization Review Committee to support regulatory compliance and continuous improvement in utilization practices.

• Monitor length of stay and avoidable days; report trends to the Utilization Review Committee
• Investigate denials, inappropriate admission order status, and other financial risks in collaboration with Revenue Cycle and finance teams
• Support compliant utilization practices and efficient patient transitions

What is required...

• Graduate of an accredited nursing program with a current Washington State Registered Nurse (RN) license or Multistate License (MSL) with Washington endorsement (maintenance required)
• Minimum of 3 years of clinical nursing experience in acute care
• Experience with evidence-based care guidelines such as Inter Qual or MCG
• Familiarity with CMS Conditions of Participation, commercial health insurance and managed care billing requirements

• Bachelor of Science in Nursing (BSN)
• Experience working with Cerner EHR
• Knowledge of care guidelines from MCG
• Hospital case management experience

Wage: Wage range currently starts at $44.70/hour and goes up to $79.60/hour. Actual wage will be based on years of applicable experience. This position may also qualify for an additional 15% premium in lieu of benefits.

FTE: Per Diem

Benefits: This position is not benefits eligible

Union Status: This is a WSNA union covered position