Appeals RN, Care Management, Per Diem

This is a fully remote position, open to applicants in California.

📋 Description

• Oversee and facilitate clinically-based appeals between Providence Health and Services, California Region and external payers.

• Ensure that appeals processes are centered around patient needs, consistent, and compliant with regulations.

• Advocate for the reimbursement of services rendered to patients within PH&S ministries.

• Assist with overall Care Management Recovery Advocate (CMRA) initiatives.

• Work on a per diem basis, with 8-hour shifts during the day.

⛳️ Requirements

• An Associate's Degree in Nursing is required.

• A California Registered Nurse License must be obtained upon hire.

• A minimum of 4 years of direct patient care experience in an acute hospital environment is necessary.

• At least 4 years of experience as a case manager within an acute hospital setting is required.

• Preferred qualifications include a Bachelor’s Degree in Nursing or a Master's Degree in Nursing.

• A case management certification is preferred at the time of hire.

• Experience with denials and appeals in an acute care context is preferred.

• Familiarity with multi-hospital systems and/or integrated healthcare organizations is preferred.

🏝️ Benefits

• Retirement 401(k) Savings Plan with employer matching.

• Comprehensive health care benefits including medical, dental, and vision coverage.

• Life insurance coverage.

• Disability insurance options.

• Paid parental leave.

• Vacation time and paid holidays/time off benefits.

• Voluntary benefits available.

• Access to well-being resources.

• Additional compensation opportunities may include shift differentials, standby/on-call pay, overtime, premiums, extra shift incentives, or bonuses.