Care Manager RN - Utilization Management (Per Diem Day)

About the role

Care Manager 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.

Responsibilities

• Provide overall management and communication of clinically-based appeals between Providence Health and Services, California Region (PH&S) and outside payers.
• Ensure activities are patient-focused, uniform, compliant, and support steadfast advocacy for reimbursement of services provided to patients served within the PH&S ministries.

Requirements

• 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

Qualifications

• Bachelor’s Degree in Nursing or Master's Degree in Nursing (preferred)
• Case management certification (upon hire, preferred)
• Experience working with denials and appeals in/for an acute care setting (preferred)
• Experience in a multi-hospital and/or integrated healthcare system (preferred)
• Familiarity with Revenue Cycle processes (preferred)
• Working knowledge of regulations and provider contracts governing coverage of inpatient services (e.g., Medicare, Medi-Cal, Commercial Payers) (preferred)

Benefits

Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well‑being resources and much more. Learn more at providence.jobs/benefits.

Pay

Pay range: $57.28 – $88.92 (base pay). Additional compensation may be available for this role, such as shift differentials, standby/on‑call, overtime, premiums, extra shift incentives, or bonus opportunities.

Schedule

Per Diem position; 8‑hour day shifts.