Care Manager RN – Utilization Management

Providence

. Provide overall management and communication of clinically-based appeals between Providence Health and Services, California Region, and outside payers .

Posted 9/17/2026part-timeRemote • California • United StatesMid-LevelSenior💰 $57 - $89 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in case management and appeals processes within acute hospital settings, ensuring compliance and patient-focused advocacy for reimbursement. Possesses strong knowledge of regulations and provider contracts related to inpatient services.

Highest-signal resume keywords

California Registered Nurse LicenseCase Management CertificationDirect Patient Care ExperienceExperience with Denials and AppealsFamiliarity with Revenue Cycle Processes

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Case ManagementPatient CareAppeals ManagementRegulatory KnowledgeInpatient Services Coverage

Soft Skills

CommunicationAdvocacy

Certifications & Qualifications

Associate's Degree in NursingBachelor’s Degree in NursingMaster's Degree in Nursing

Industry Keywords

Acute Hospital SettingMulti-Hospital SystemIntegrated Healthcare SystemMedicareMedi-Cal

About the role

Key responsibilities & impact

Provide overall management and communication of clinically-based appeals between Providence Health and Services, California Region, and outside payers
Ensure activities are patient-focused, uniform, and compliant
Advocate for reimbursement of services provided to patients served within Providence Health and Services ministries

Requirements

What you’ll need

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 case management experience in an acute hospital setting
Case management certification upon hire preferred
Bachelor’s Degree in Nursing preferred
Master's Degree in Nursing 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, including Medicare, Medi-Cal, and commercial payers, preferred

Benefits

Comp & perks

Retirement 401(k) Savings Plan with employer matching
Medical, dental, and vision benefits
Life insurance
Disability insurance
Paid parental leave
Vacation and holiday time off
Health-issue time off benefits
Voluntary benefits
Well-being resources
Additional compensation may be available through shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities