Care Manager - Appeals RN - Utilization Management

Providence; Torrance (CA); Remote; USD 92,000 - 129,000; Part time

Job summary

Providence California Regional Services is seeking a Care Manager Appeals RN for a remote per diem role. The position supports day shifts and focuses on managing and communicating clinically-based appeals with outside payers to ensure reimbursement for services to patients in PH&S ministries.

The CMRA role emphasizes advocacy, patient-centered communication, and adherence to regulatory standards. Required RN license in California, associate degree, and several years of acute-care and

Qualifications

• Must hold California RN license at hire.
• 4 years direct patient care experience in an acute hospital setting.
• 4 years experience as a case manager in an acute hospital setting.

Responsibilities

• Manage and communicate clinically-based appeals between Providence Health and Services, California Region and outside payers.
• Support reimbursement advocacy for services provided to patients served within the PH&S ministries.

Skills

Acute care nursing

Case management

Communication

Education

Associate's Degree in Nursing

Bachelor's Degree in Nursing

Master's Degree in Nursing

Job description

Care Manager AppealsRN - REMOTE position. 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.

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.
Required Qualifications:

• Associate's Degree in Nursing.
• California Registered Nurse License upon hire
• 4 yearsdirect patient care experience in an acute hospital setting.
• 4 yearsexperience 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?

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.