Care Manager RN - Utilization Management
About The Position
The Care Manager RN (Care Management Recovery Advocate) is responsible for overall management and communication of clinically based appeals between Providence Health and Services, California Region, and outside payers. Activities are patient-focused, uniform, and compliant, and support advocacy for reimbursement of services provided to patients within Providence ministries. This is a full-time, remote position working 8-hour day shifts. Providence California Regional Services describes its culture as patient-focused, whole-person care built on understanding, commitment, and mutual respect. The organization emphasizes empowering caregivers and supporting care for everyone, especially vulnerable community members.
Requirements
- Associate's Degree in Nursing.
- California Registered Nurse License upon hire.
- 4 years of direct patient care experience in an acute hospital setting.
- 4 years of experience as a case manager in an acute hospital setting.
Nice To Haves
- Bachelor's Degree in Nursing or 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 within Providence ministries.
- Ensure activities are patient-focused, uniform, and compliant.
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
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
