Care Manager RN – Utilization Management

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

📋 Description

• Manage and facilitate communication regarding clinically based appeals between Providence Health and Services, California Region, and external payers.

• Ensure that activities are centered around patient care, consistent, and compliant with regulations.

• Advocate for the reimbursement of services provided to patients within Providence ministries.

• Support the mission of Providence in delivering patient-focused, whole-person care.

⛳️ Requirements

• Associate's Degree in Nursing is required.

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

• Minimum of 4 years of direct patient care experience in an acute hospital environment.

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

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

• Case management certification is preferred upon hire.

• Experience in handling denials and appeals in an acute care environment is preferred.

• Experience in a multi-hospital and/or integrated healthcare system is preferred.

🏝️ Benefits

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

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

• Life insurance coverage.

• Disability insurance options.

• Paid parental leave for eligible employees.

• Vacation time for personal use.

• Paid holidays throughout the year.

• Time off available for health-related issues.

• Voluntary benefits for additional support.

• Access to well-being resources.

• Commitment to an inclusive workplace and equal opportunities for career advancement.