Care Manager - Appeals RN - Utilization Management
Providence•Torrance, CA
•Remote
About The Position
The Care Management Recovery Advocate (CMRA) manages and communicates clinically based appeals between Providence Health and Services, California Region (PH&S), and outside payers. Activities are patient-focused, uniform, and compliant, and support advocacy for reimbursement of services provided to patients served within PH&S ministries. This is a remote, per diem position working 8-hour day shifts.
Requirements
- Associate's degree in Nursing.
- California Registered Nurse license upon hire.
- Four years of direct patient care experience in an acute hospital setting.
- Four years of experience as a case manager in an acute hospital setting.
Nice To Haves
- Bachelor's degree in Nursing or a Master's degree in Nursing.
- Case management certification upon hire.
- Experience working with denials and appeals in or for an acute care setting.
- Experience in a multi-hospital and/or integrated healthcare system.
Responsibilities
- Manage clinically based appeals between Providence Health and Services, California Region, and outside payers.
- Communicate clinically based appeals.
- Support advocacy for reimbursement of services provided to patients served within PH&S ministries.
Benefits
- Benefits designed to support employees and their families in staying well, growing professionally, and achieving financial security.
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What This Job Offers
Career Level
Mid Level
Education Level
Associate degree
