Care Manager RN - Utilization Management

Providence Health Plan Group; Torrance, Northern (CA, KY); Hybrid; USD 164,130,000 - 254,793,000; Full time

Job summary

Providence California Regional Services is seeking a Care Manager RN for a remote, full-time role. The position involves day shifts and focuses on coordinating clinically-based appeals and reimbursement processes for patients across PH&S California regions.

Candidate must have an Associate's Degree in Nursing, CA RN license, and at least four years of direct patient care and case management experience in an acute hospital setting.

Qualifications

• 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 processes and advocate for patients served within PH&S ministries.

Education

Associate's Degree in Nursing

California Registered Nurse License

Job description

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-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.
• Upon hire: California Registered Nurse License
• 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.
• Upon hire: Case management certification
• 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.

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.

Providence offers 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. Learn more at providence.jobs/benefits.
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.

About the Team

The Sisters of Providence and Sisters of St. Joseph of Orange have deep roots in California, bringing health care and education to communities from the redwood forests to the beach shores of Orange county - and everywhere in between. In Southern California, Providence provides care throughout Los Angeles County, Orange County, High Desert and beyond.

Our award-winning and comprehensive medical centers are known for outstanding programs in cancer, cardiology, neurosciences, orthopedics, women's services, emergency and trauma care, pediatrics and neonatal intensive care. Our not-for-profit network provides a full spectrum of care with leading-edge diagnostics and treatment, outpatient health centers, physician groups and clinics, numerous outreach programs, and hospice and home care, and even our own Providence High School.

Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement.

Requsition ID: 454390
Company: Providence Jobs
Job Category: Care Management
Job Function: Clinical Care
Job Schedule: Full time
Job Shift: Day
Career Track: Nursing
Department: 7000 UTILIZATION MGMT CA SOCAL
Address: CA Torrance 21311 Madrona Ave
Work Location: PMI Madrona-Torrance
Workplace Type: Remote
Pay Range: $57.28 - $88.92
The amounts listed 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.