California Licensed Care Manager RN

Job Summary

To support effective utilization management, the full-time California Licensed Care Manager RN will oversee clinically based appeals and advocate for reimbursement of services provided to patients, working remotely during day shifts.

Key responsibilities:

• Manage and communicate clinically based appeals between Providence Health and Services and outside payers
• Ensure patient-focused and compliant activities that support advocacy for service reimbursement
• Collaborate with various stakeholders to facilitate effective care management processes

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