Care Manager RN - Appeals

Manages specific patients throughout their admission to ensure the availability of sufficient clinical and medical center resources. Communicates on a daily basis with medical staff, medical center personnel and outside resources to ensure the appropriate utilization of resources according to clinical and financial standards. Monitors the medical record for variances to clinical and financial standards and intervenes to achieve the optimum outcome for the patient and the medical center. Is able to incorporate risk management and infection control knowledge for the purpose of assisting the healthcare team to achieve a desired outcome. Identifies issues, which expose the organization to liability and financial risk, and assists to minimize the risk by collaborating with management, medical staff and medical center personnel. Provides payor/utilization review organizations with concurrent retrospective utilization review required for reimbursement.

Providence caregivers are not simply valued – they’re invaluable. Join our team at Santa Rosa Memorial Hospital 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.

Required Qualifications

• Coursework/Training: Environmental Orientation due within 30 days of hire.
• Coursework/Training: Case Management Competency due within 90 days of hire.
• Coursework/Training: General Nurse Competency due within 30 days of hire.
• California Registered Nurse License upon hire.
• 2 years of Acute nursing experience, with evidence of progressive clinical experience preferred, Or
• Case management experience.

Preferred Qualifications

• Bachelor’s Degree in Nursing upon hired, must obtain BSN within 3 years of date of hire.
• CCM upon hire
• 3 years of Acute nursing experience, with evidence of progressive clinical experience preferred, Or
• Case management experience.

Why Join Providence?

Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.

At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) 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. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. 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.

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 .

Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act .