Care Manager RN - Utilization Management

Providence; Torrance (CA); Remote; USD 90,000 - 120,000; Full time

Job summary

Providence California Regional Services is seeking a Care Manager RN for a remote, full-time role. The position oversees clinical appeals coordination between Providence Health and Services and outside payers, emphasizing patient-focused advocacy and compliant processes.

The ideal candidate holds an associate degree in nursing, an active California RN license, and at least four years of direct patient care and case management in an acute hospital setting, with preferred nursing degrees and

Qualifications

• RN license is required upon hire.
• Associate's Degree in Nursing required.
• 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.

Responsibilities

• Coordinate clinically based appeals communications with Providence Health and Services and external payers.
• Advocate for reimbursement of services for patients served within PH&S ministries.
• Ensure patient-focused, compliant, and uniform management of appeals.
• Collaborate with California Region teams to support denials and appeals.

Skills

Direct patient care

Case management

Acute care experience

Education

Associate's Degree in Nursing

Bachelor's Degree in Nursing (preferred)

California RN License

Job description

Care Manager RN - REMOTE position. This position is Full time and will work 8- hour, Day shifts.

The Care Management Recovery Advocate (CMRA) is responsible for providing overall management and communication of clinically basedappeals 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. Responsibilities are not limited to, but will include:

Providence caregivers are not simply valued – they’re invaluable. Join our team atProvidence California Regional Servicesand 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 years of Direct patient care experience in an acute hospital setting.
• 4 years of Experience as a case manager in an acute hospital setting.
  

Preferred Qualifications:

• Bachelor's Degree in Nursing, Or
• Master's Degree inNursing.
• 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?

Ourbest-in-class benefitsare 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 ourMissionof caring for everyone, especially the most vulnerable in our communities.