Providence Health & Services

Care Manager RN - Utilization Management

Providence Health & Services$85K — $100K *
Healthcare
Less than 5 years of experience
Job Overview by Ladders

Qualifications

  • Associate's Degree in Nursing is required.
  • California Registered Nurse License required upon hire.
  • 4 years of direct patient care experience in an acute hospital setting.
  • 4 years of experience as a case manager in an acute hospital setting.
  • Case management certification is preferred at hire.

Responsibilities

  • Manage clinical appeals between Providence Health Services and outside payers.
  • Advocate for reimbursement of services provided to patients.
  • Ensure patient-focused care is compliant and uniform.
  • Communicate effectively with various stakeholders involved in patient care.
  • Support comprehensive request documentation and follow-up processes.

Benefits

  • Comprehensive health care benefits including medical, dental, and vision.
  • 401(k) Savings Plan with employer matching.
  • Paid time off benefits including parental leave and vacations.
  • Life and disability insurance.
  • Access to wellness resources and voluntary benefits.
Full Job Description
Job Description

Care Manager RN - REMOTE position. This position is Full time and will work 8- hour, Day shifts.

The Care Management Recovery Advocate (CMRA) is responsible for providing overall management and communication of clinically-based appeals between Providence Health and Services, California Region (PH&S) outside payers. Activities will be patient-focused, uniform, compliant, and support steadfast advocacy for reimbursement of services provided to patients served within the PH&S ministries.

Required Qualifications:
  • 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 Qualifications:
  • Bachelor's Degree in Nursing or,
  • Master's Degree in Nursing.
  • Upon hire: Case management certification
  • Experience working with denials and appeals in/for an acute care setting.
  • Experience in a multi-hospital and/or integrated healthcare system.


Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits.

About the Team

The Sisters of Providence and Sisters of St. Joseph of Orange have deep roots in California, bringing health care and education to communities from the redwood forests to the beach shores of Orange county - and everywhere in between. In Southern California, Providence provides care throughout Los Angeles County, Orange County, High Desert and beyond.

Our award-winning and comprehensive medical centers are known for outstanding programs in cancer, cardiology, neurosciences, orthopedics, women's services, emergency and trauma care, pediatrics and neonatal intensive care. Our not-for-profit network provides a full spectrum of care with leading-edge diagnostics and treatment, outpatient health centers, physician groups and clinics, numerous outreach programs, and hospice and home care, and even our own Providence High School.

About Providence Health & Services

Providence Health & Services is a not-for-profit Catholic health care system operating multiple hospitals across five states in the Western United States. The system was founded in 1856 by the Sisters of Providence. Providence Health & Services is the largest health care provider in Washington state, employing more than 35,000 people across its hospitals, clinics, and other facilities. The system is known for its focus on community health and wellness, and has been recognized for its commitment to quality care and patient safety. Providence Health & Services is also a leader in medical research and education, with a number of partnerships with universities and other institutions.
Learn more about Providence Health & Services
Size
120,000 employees
Industry
Founded
1859

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