Care Manager RN - Utilization Management

Agence PROvidence; United States; On-site; USD 85,000 - 115,000; Full time

Job summary

Providence California Regional Services is seeking a Care Manager RN for a remote, full-time role with day shifts. The CMRA will coordinate clinically based appeals between PH&S and outside payers, focusing on patient-centered advocacy for reimbursement of services.

Ideal candidates hold an Associate Degree in Nursing, CA RN license, and at least 4 years of direct patient care and case management experience in acute care settings. Preferred may include higher nursing degrees and certification.

Qualifications

• Associate's Degree in Nursing required.
• California RN license required upon hire.
• Minimum of 4 years direct patient care in an acute hospital setting.
• Minimum of 4 years as a case manager in an acute hospital setting.

Responsibilities

• Provide overall management and communication of clinically based appeals between Providence Health and Services and external payers.
• Support reimbursement advocacy for services provided to patients served within PH&S, California Region.
• Maintain patient-focused, compliant processes and professional communication across teams.

Skills

Direct patient care

Case management

Communication skills

Nursing license

Education

Associate's Degree in Nursing

Bachelor's Degree in Nursing

Master's Degree in Nursing

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. Responsibilities are not limited to, but will include:

Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence 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 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?

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.