Appeals RN - Care Management Full-time - REMOTE
About the role
The Care Management Recovery Advocate (CMRA) provides overall management and communication of clinically-based appeals between Providence Health and Services, California Region (PH&S) and outside payers. Activities are patient-focused, uniform, compliant, and support steadfast advocacy for reimbursement of services provided to patients within the PH&S ministries.
Responsibilities
- Manage and communicate clinically-based appeals with outside payers.
- Advocate for reimbursement of services provided to patients.
- Ensure activities are patient-focused, uniform, and compliant.
Requirements
- Associate's Degree in Nursing (required).
- California Registered Nurse License (required 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.
Qualifications
- Bachelor’s Degree in Nursing (preferred).
- Master's Degree in Nursing (preferred).
- Case management certification (preferred upon hire).
- Experience working with denials and appeals in/for an acute care setting (preferred).
- Experience in a multi-hospital and/or integrated healthcare system (preferred).
About Providence
At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” We foster an inclusive workplace where diversity is valued, and everyone is essential, heard, and respected. Together, our 120,000 caregivers serve in over 50 hospitals, over 1,000 clinics, and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas, and Washington.
Benefits
- Retirement 401(k) Savings Plan with employer matching.
- Health care benefits (medical, dental, vision).
- Life insurance and disability insurance.
- Time off benefits (paid parental leave, vacations, holidays, health issues).
- Voluntary benefits and well-being resources.
Pay
Pay range: $57.28 - $88.92 per hour. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Schedule
Full time, Day shift.
Work Location: Providence Administrative Offices-Earl Street, Torrance, CA (on-site).