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

📋 Description

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

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

• Advocate for the reimbursement of services rendered to patients within the Providence Health and Services ministries.

⛳️ Requirements

• Associate's Degree in Nursing.

• California Registered Nurse License required upon hire.

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

• At least 4 years of case management experience in an acute hospital setting.

• Case management certification preferred upon hire.

• Bachelor’s Degree in Nursing is preferred.

• Master's Degree in Nursing is preferred.

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

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

• Familiarity with Revenue Cycle processes is preferred.

• Understanding of regulations and provider contracts related to coverage of inpatient services, including Medicare, Medi-Cal, and commercial payers, is preferred.