Providence Health & Services Care Management - Recovery Advocate Registered Nurse in Torrance, California
Providence is calling a Full Time, Day Shift Care Management Recovery Advocate Registered Nurse to Providence Health & Services, Southern California Region.
In this position you will:
Provide overall management and communication of clinically-based appeals between Providence Health and Services, California Region ( PH & S ) and outside payers
Review all denied services secondary to medical necessity, regardless of payer, and where appropriate
Facilitate communication between, and act as liaison for medical necessity denial and appeal
Required qualifications for this position include:
Current California Registered Nurse ( RN ) license
Associate's Degree In Nursing
Minimum of 2 years direct patient care experience in an acute care setting
Thorough knowledge of principles and practices of health care
Excellent writing skills, organizational and analytical skills with strong abilities for independent decision making and problem solving
Preferred qualifications for this position include:
Bachelor's Degree in Nursing ( BSN ) or Master's Degree in Nursing ( MSN )
Case Management certification
5 plus years of direct patient care experience in an acute care setting
Previous experience working with denials and appeals in/for an acute care setting
Previous experience as a case manager in an acute care setting
Experience in a multi-hospital and/or integrated healthcare system
Familiarity with Revenue cycle processes
Working knowledge of regulations and provider contracts governing coverage of inpatient services (e.g., Medicare, Medi-Cal, Commercial Payers)
About the Region you will serve.
For nearly 70 years, Providence Health & Services, Southern California, has provided quality and compassionate health care, building on a tradition of excellence, innovation, teamwork and outreach to those most in need.
Anchored by five award-winning comprehensive medical centers, Providence provides a full spectrum of care that includes a range of specialties, signature services, outpatient and home care and the well-regarded Providence Medical Institute, a group of physicians and primary and urgent care clinics throughout the greater San Fernando Valley and South Bay. Providence is focused on providing the communities it serves with preventive care, education and leading-edge diagnostics and treatment. The organization includes numerous outreach programs. hospice and home care and even our own Providence High School, a Blue Ribbon college-preparatory campus.
We offer a full comprehensive range of benefits - see our website for details
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence Health & Services is a not-for-profit Catholic network of hospitals, care centers, health plans, physicians, clinics, home health care and services guided by a Mission of caring the Sisters of Providence began over 160 years ago. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Case Management
Req ID: 214574