Providence Health & Services Registered Nurse - Prior Authorization/Claims Care Coordinator in Beaverton, Oregon


Providence is calling a Registered Nurse - Quality Medical Management Care Coordinator to Providence Health Plan in Beaverton, OR.

In this position, you 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.

  • Facilitate these programs which are developed to manage medical expense, determine medically appropriate services and define clinical criteria for decision making.

  • Provide retrospective review of claims and other data, as well as care coordination and discharge planning.


Required qualifications for this position include:

  • Currently licensed as a Registered Nurse (RN) in Oregon

  • Valid driver's license

  • 5 years of clinical nursing experience

  • Demonstrated creativity and flexibility in problem solving and development of alternative approaches to the traditional delivery of health care

  • Experience working with physicians in collaboration and management of patient care and/or utilization review

Preferred qualifications for this position include:

  • Bachelor's degree in nursing or healthcare

  • Experience in utilization review, discharge planning and/or managed care

  • Experience with InterQual

About Providence in Oregon

As the largest healthcare system and largest private employer in Oregon, Providence offers exceptional work environments and unparalleled career opportunities.

The Providence Experience begins each time our patients or their families have an encounter with a Providence team member and continues throughout their visit or stay. Whether you provide direct or indirect patient care, we want our patients to feel that they are in a welcoming place where they can be comfortable and free from anxiety. Our employees create the Providence Experience through simple, caring behaviors such as acknowledging and welcoming each visitor, introducing ourselves and Providence, addressing people by name, providing the duration of estimated wait times and updating frequently if timelines change, explaining situations in a way that puts patients at ease, carefully listening to their concerns, and always thanking people for trusting Providence for their healthcare needs. At Providence, our quality vision is simple,

"Providence will provide the best care and service to every person, every time."

Providence is consistently ranked among the top 100 companies to work for in Oregon. It is also home to two of our award-winning Magnet medical centers. Providence hospitals and clinics are located in numerous areas, ranging from the Columbia Gorge to the wine country to sunny southern Oregon to charming coastal communities to the urban setting of Portland. If you want a vibrant lifestyle while working with a team highly committed to the art of healing, choose from our many options in Oregon.

We offer a full comprehensive range of benefits - see our website for details

Our Mission

As people of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service.

About Us

Providence Health & Services is the third largest not-for-profit health system in the United States. Providence employs more than 82,000 caregivers (employees) across a five-state area; AK, WA, MT, OR, and CA. Our facilities include 34 hospitals, 600 physician clinics, senior services, supportive housing and other health and educational services. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.

Schedule: Full-time

Shift: Day

Job Category: Health Plan/Insurance Nursing

Location: Oregon-Beaverton

Req ID: 184006