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.

• Act as an advocate for the reimbursement of services rendered to patients within Providence ministries.

• Ensure that all activities are focused on patient care, consistent, and compliant with regulations.

• Conduct care management recovery advocacy within Providence California Regional Services.

• Work on a full-time basis during 8-hour day shifts.

⛳️ Requirements

• Possess an Associate's Degree in Nursing.

• Hold a California Registered Nurse License at the time of hire.

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

• Demonstrate 4 years of experience as a case manager in an acute hospital setting.

• Bachelor’s Degree in Nursing is preferred.

• Master’s Degree in Nursing is preferred.

• Case management certification upon hire is preferred.

• Experience with denials and appeals in/for an acute care setting is preferred.

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

🏝️ Benefits

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

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

• Life insurance coverage.

• Disability insurance options.

• Paid parental leave policy.

• Vacation and holiday time off.

• Health issue time off benefits.

• Voluntary benefits available.

• Access to well-being resources.

• Opportunities for professional career support and development.

• An inclusive workplace that values diversity.