California Licensed Appeals RN

Job Summary

Managing clinically based appeals, the full-time California Licensed Appeals RN will oversee communication between Providence Health and Services and outside payers, ensuring patient-focused advocacy for reimbursement of services in a remote setting.

Key responsibilities

• Provide overall management and communication of appeals related to patient care
• Ensure compliance and uniformity in the appeals process while advocating for patient reimbursement
• Collaborate with clinical teams to support effective appeal strategies and patient outcomes

Required qualifications

• Associate's Degree in Nursing
• California Registered Nurse License upon hire
• 2 years of direct patient care experience in an acute care setting
• 2 years of experience as a case manager in an acute care setting