Care Manager, RN – Utilization Management
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Job Description
Care Manager RN managing clinically based appeals and reimbursement advocacy for Providence’s California healthcare network. Coordinating patient-focused communications with outside payers.
Responsibilities:
- Provide overall management and communication of clinically-based appeals between Providence Health and Services, California Region, and outside payers
- Keep activities patient-focused, uniform, and compliant
- Advocate for reimbursement of services provided to patients served within Providence Health and Services ministries
Requirements:
- 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: Bachelor's Degree in Nursing or Master's Degree in Nursing
- Preferred: Upon hire, case management certification
- Preferred: Experience working with denials and appeals in/for an acute care setting
- Preferred: Experience in a multi-hospital and/or integrated healthcare system
Benefits:
- Retirement 401(k) Savings Plan with employer matching
- Health care benefits (medical, dental, vision)
- Life insurance
- Disability insurance
- Paid parental leave
- Vacation and holiday time off
- Health-related time off benefits
- Voluntary benefits
- Well-being resources
- Additional compensation may be available through shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities
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