Remote Care Manager RN – Appeals & Denials Expert

Agence PROvidence; Torrance (CA); Remote; USD 79,000 - 122,000; Part time

Job summary

Providence California Regional Services is seeking a Care Manager Appeals RN (remote, per diem) to oversee clinically-based appeals and advocate for reimbursement of services. The CMRA will coordinate with Providence and external payers, ensuring patient-focused, compliant processes across the California region.

The role requires an RN with an Associate's degree, California license, and 4 years of direct patient care plus 4 years as a case manager in acute care.

Qualifications

• Required: Associate's Degree in Nursing.
• Required: California Registered Nurse License upon hire.
• Required: 4 years direct patient care experience in an acute hospital setting.
• Required: 4 years experience as a case manager in an acute hospital setting.
• Preferred: Bachelor's Degree in Nursing or Master's Degree in Nursing.
• Preferred: Case management certification upon hire.
• Preferred: Experience working with denials and appeals in an acute care setting.
• Preferred: Experience in a multi-hospital and/or integrated healthcare system.

Responsibilities

• Manage and communicate clinically-based appeals between Providence Health and Services, California Region and outside payers.
• Maintain patient-focused, uniform, and compliant processes to support reimbursement for services.
• Advocate for timely and accurate reimbursement for patients served within the PH&S ministries.

Education

Associate's Degree in Nursing

California Registered Nurse License

Job description

Providence California Regional Services is seeking a Care Manager Appeals RN (remote, per diem) to oversee clinically-based appeals and advocate for reimbursement of services. The CMRA will coordinate with Providence and external payers, ensuring patient-focused, compliant processes across the California region.

The role requires an RN with an Associate's degree, California license, and 4 years of direct patient care plus 4 years as a case manager in acute care.