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 10/6/2026full-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 patient advocacy within acute hospital settings, ensuring compliance and effective communication with payers. Holds relevant nursing degrees and certifications to support reimbursement processes and care management.

Highest-signal resume keywords

California Registered Nurse LicenseCase Management CertificationDirect Patient Care ExperienceExperience with Denials and AppealsExperience in Acute Hospital Setting

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Case ManagementPatient AdvocacyCare Management RecoveryReimbursement ProcessesClinical Appeals Management

Soft Skills

CommunicationPatient-Focused ApproachAdvocacy

Certifications & Qualifications

Associate's Degree in NursingBachelor's Degree in Nursing (Preferred)Master's Degree in Nursing (Preferred)Case Management Certification (Preferred)

Industry Keywords

Acute Care SettingMulti-Hospital SystemIntegrated Healthcare SystemCompliance

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
Advocate for reimbursement of services provided to patients within Providence ministries
Ensure activities are patient-focused, uniform, and compliant
Perform care management recovery advocacy within Providence California Regional Services
Work full-time, 8-hour day shifts

Requirements

What you’ll need

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
Bachelor's Degree in Nursing preferred
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

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 and holiday time off
Health issue time off benefits
Voluntary benefits
Well-being resources
Professional career support and development
Inclusive workplace where diversity is valued