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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 10/27/2026full-timeRemote • California • United StatesMid-LevelSenior💰 $57 - $89 per hourWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in case management and patient advocacy within acute hospital settings, ensuring compliance and effective communication with payers. Holds a California Registered Nurse License and possesses extensive experience in managing clinically based appeals and denials.
Highest-signal resume keywords
California Registered Nurse LicenseCase Management ExperiencePatient Care ExperienceDenials And Appeals ManagementAssociate's Degree In Nursing
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Case ManagementPatient AdvocacyClinical Appeals ManagementAcute Care ExperienceCompliance Assurance
Soft Skills
CommunicationPatient-Focused ApproachCollaboration
Certifications & Qualifications
Case Management Certification
Industry Keywords
Acute Hospital SettingIntegrated Healthcare SystemReimbursement AdvocacyWhole-Person Care
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 ministries
- Support Providence's patient-focused, whole-person care mission
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 experience as a case manager in an acute hospital setting
- Preferred: 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
Benefits
Comp & perks- Retirement 401(k) Savings Plan with employer matching
- Medical, dental, and vision health care benefits
- Life insurance
- Disability insurance
- Paid parental leave
- Vacation time
- Paid holidays
- Time off for health issues
- Voluntary benefits
- Well-being resources
- Inclusive workplace and equal opportunities for advancement