Remote RN Care Manager: Denials & Appeals

Providence; Torrance (CA); À distance; USD 90 000 - 120 000; Plein temps

Résumé du poste

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.

Responsabilités

• 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.

Connaissances

Direct patient care

Case management

Acute care experience

Formation

Associate's Degree in Nursing

Bachelor's Degree in Nursing (preferred)

California RN License

Description du poste

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