California Licensed Care Manager RN

Job Summary

To support patient advocacy efforts, the per diem Care Manager RN - Utilization Management will manage clinically-based appeals, ensuring compliance and effective communication with outside payers while working day shifts remotely.

Key responsibilities

• Manage and communicate clinically-based appeals between Providence Health and Services and outside payers
• Provide patient-focused care and advocate for reimbursement of services provided to patients
• Ensure compliance with regulations and support uniformity in care management practices

Required qualifications

• 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 experience as a case manager in an acute hospital setting