Care Manager - Appeals RN - Utilization Management

Agence PROvidence; Torrance (CA); Remote; USD 79,000 - 122,000; Part time

Job summary

Providence California Regional Services is seeking a Care Manager Appeals RN (remote, per diem) to oversee clinically-based appeals and advocate for reimbursement of services. The CMRA will coordinate with Providence and external payers, ensuring patient-focused, compliant processes across the California region.

The role requires an RN with an Associate's degree, California license, and 4 years of direct patient care plus 4 years as a case manager in acute care.

Qualifications

• Required: Associate's Degree in Nursing.
• Required: California Registered Nurse License upon hire.
• Required: 4 years direct patient care experience in an acute hospital setting.
• Required: 4 years experience as a case manager in an acute hospital setting.
• Preferred: Bachelor's Degree in Nursing or Master's Degree in Nursing.
• Preferred: Case management certification upon hire.
• Preferred: Experience working with denials and appeals in an acute care setting.
• Preferred: Experience in a multi-hospital and/or integrated healthcare system.

Responsibilities

• Manage and communicate clinically-based appeals between Providence Health and Services, California Region and outside payers.
• Maintain patient-focused, uniform, and compliant processes to support reimbursement for services.
• Advocate for timely and accurate reimbursement for patients served within the PH&S ministries.

Education

Associate's Degree in Nursing

California Registered Nurse License

Job description

Care Manager Appeals RN - Remote

This position is Per Diem and will work 8-hour day shifts.

The Care Management Recovery Advocate (CMRA) is responsible for providing overall management and communication of clinically-based appeals between Providence Health and Services, California Region (PH&S) outside payers. Activities will be patient-focused, uniform, compliant, and support steadfast advocacy for reimbursement of services provided to patients served within the PH&S ministries.

Required Qualifications

• Associate's Degree in Nursing.
• California Registered Nurse License upon hire
• 4 years direct patient care experience in an acute hospital setting.
• 4 years experience as a case manager in an acute hospital setting.

Preferred Qualifications

• Bachelor's Degree in Nursing. -Or-
• Master's Degree in Nursing
• Case management certification upon hire
• Experience working with denials and appeals in/for an acute care setting.
• Experience in a multi-hospital and/or integrated healthcare system.

Why Join Providence?

Providence caregivers are not simply valued – they're invaluable. Join our team at Providence California Regional Services 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.

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.

About Providence

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.

We offer 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.

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.

Pay Range: $57.28 - $88.92