[Hiring] Care Manager RN - Utilization Management @Providence

Role Description

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. Responsibilities are not limited to, but will include:

• Providing overall management and communication of clinically based appeals.
• Ensuring patient-focused and compliant activities.
• Advocating for reimbursement of services provided to patients.

Qualifications

• Associate's Degree in Nursing.
• California Registered Nurse License upon hire.
• 4 years Direct patient care experience in an acute hospital setting.
• 4 years Experience as a case manager in an acute hospital setting.

Requirements

• Bachelor's Degree in Nursing, Or Master's Degree in Nursing (preferred).
• Case management certification upon hire (preferred).
• Experience working with denials and appeals in/for an acute care setting (preferred).
• Experience in a multi-hospital and/or integrated healthcare system (preferred).

Benefits

• Comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching.
• Health care benefits (medical, dental, vision).
• Life insurance and disability insurance.
• Time off benefits (paid parental leave, vacations, holidays, health issues).
• Voluntary benefits and well-being resources.
• Additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.