Providence

Not-for-profit health system with hospitals

Care Manager - Appeals RN, Utilization Management

Medical, Clinical & VeterinaryConfirmed live in the last 24 hours

Full-timeRemote in USA$57.28 - $88.92

About the Job

Requirements

An Associate's Degree in Nursing is required.
A California Registered Nurse license is required upon hire.
Four years of direct patient-care experience in an acute hospital setting are required.
Four years of case-manager experience in an acute hospital setting are required.

Responsibilities

Manage and communicate clinically based appeals between Providence Health and Services, California Region, and outside payers.
Ensure appeals activities are patient-focused, uniform, and compliant, and advocate for reimbursement of services provided to patients served within Providence ministries.

Desired Qualifications

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

Care Manager Appeals RN - REMOTE position. This position is Per Diem and will work 8- hour, Day shifts.

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.

Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence California Regional Services and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.

Required 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.

Preferred Qualifications:

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

Why Join Providence?

Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.

Minimum Salary: 57.28

Maximum Salary: 88.92

About the Company

Providence

Not-for-profit health system with hospitals

Providence Health & Services is a not-for-profit healthcare system operating 51 hospitals and over 1,000 clinics in seven western states, offering outpatient care, hospital care, home health, hospice, substance abuse programs, and mental health services. Care is delivered by about 122,000 caregivers, with revenue from patient services reinvested into ongoing care and community programs, all rooted in faith-based values. It differentiates itself by reinvesting earnings into care and community services rather than distributing profits, and by leveraging a large, integrated network to pursue scale and efficiency. Its goal is to strengthen financial stability while expanding access and quality of care for diverse communities.

Company size: 10,001+
Company stage: Not listed
Total funding: Not listed
Headquarters: Renton, WA
Founded: 1859

Recently Posted Jobs

Explore more opportunities at Providence

See more jobs