Care Manager RN – Utilization Management

🔥 0 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $57 - $88 / hour

⏱ Part Time

🟡 Mid-level

🟠 Senior

👔 Manager

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Providence

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1856

💼 Consulting

🛡️ Insurance

🏥 Healthcare

Consulting • Insurance • Healthcare

Providence is a not-for-profit health system committed to providing a wide range of medical services, including primary care, urgent care, pediatrics, maternity care, cancer treatment, and specialized services like neurosurgery and orthopedics. They offer both in-person and virtual care through clinics and a mobile app, ensuring patients can access healthcare conveniently. With a mission rooted in compassion, dignity, and justice, Providence emphasizes serving those who are vulnerable and strives for excellence in healthcare delivery. They are involved in research and innovation, including genomic profiling and clinical trials to improve patient outcomes.

📋 Description

• Provide overall management and communication of clinically-based appeals between Providence Health and Services, California Region, and outside payers • Ensure activities are patient-focused, uniform, and compliant • Advocate for reimbursement of services provided to patients served within Providence Health and Services ministries

🎯 Requirements

• Associate's Degree in Nursing • California Registered Nurse License upon hire • 4 years of direct patient care experience in an acute hospital setting • 4 years of case management experience in an acute hospital setting • Case management certification upon hire preferred • Bachelor’s Degree in Nursing preferred • Master's Degree in Nursing 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 • Familiarity with Revenue Cycle processes preferred • Working knowledge of regulations and provider contracts governing coverage of inpatient services, including Medicare, Medi-Cal, and commercial payers, preferred

🏖️ Benefits

• Retirement 401(k) Savings Plan with employer matching • Medical, dental, and vision benefits • Life insurance • Disability insurance • Paid parental leave • Vacation and holiday time off • Health-issue time off benefits • Voluntary benefits • Well-being resources • Additional compensation may be available through shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities