Care Manager RN - Utilization Management (Full time Day)

NEPSE Trading; United States; Remote; USD 90,000 - 120,000; Full time

Job summary

Providence California Regional Services seeks an RN Care Manager for a remote, full-time role. The position supports patient-centered care management and appeals coordination, focusing on reimbursement for services in the PH&S network.

California RN license is required along with substantial direct patient care and case management experience. The role emphasizes compliant, thoughtful communication with payers and across hospital settings to ensure ongoing access and coverage for patients served

Qualifications

• Associate's Degree in Nursing is required
• California RN License must be active at hire
• 4+ years direct patient care in acute hospital setting
• 4+ years as a case manager in acute hospital setting

Responsibilities

• Coordinate and communicate clinically-based appeals between Providence Health and Services, California Region and external payers.
• Advocate for reimbursement of services for patients served within PH&S ministries, ensuring compliance and patient focus.
• Support unified, compliant care management practices across the network.

Skills

Case management

Direct patient care

Communication

Appeals processing

Education

California Registered Nurse License

Associate's Degree in Nursing

Bachelor's Degree in Nursing

Master's Degree in Nursing

Tools

Case management software

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-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.