The Registered Nurse (RN) supports denials, appeals and compliance activities within the Care Management Department, including patient chart review, writing appeal letters and various audits supporting the Department and hospital in meeting regulatory requirements associated with Care Management.

PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Downey Hospital, PIH Health Good Samaritan Hospital, PIH Health Whittier Hospital, 37 outpatient medical office buildings, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, digestive health, orthopedics, women’s health, urgent care and emergency services. The organization is nationally recognized for excellence in patient care and patient experience, and the College of Healthcare Information Management Executives (CHIME) has identified PIH Health as one of the nation’s top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology. For more information, visit PIHHealth.org or follow us on Facebook, Twitter, or Instagram.

Required Skills

• Excellent verbal, written, and organizational skills required
• Ability to follow chain of command
• Knowledge of medical terminology and current third party payor reimbursement methodologies
• Self motivated and results oriented.
• Must be able to demonstrate sound decision making and prioritization skills, utilizes the approved process to resolve biophysical, psychological, educational and environmental needs of patient/significant others when administering or explaining care.

Required Experience

• Maintain an active California RN license.
• Minimum of 2 years acute hospital experience.
• Managed care and case management experience preferred.
• Proficiency with main-frame and personal computers

• Excellent verbal, written, and organizational skills required
• Ability to follow chain of command
• Knowledge of medical terminology and current third party payor reimbursement methodologies
• Self motivated and results oriented.
• Must be able to demonstrate sound decision making and prioritization skills, utilizes the approved process to resolve biophysical, psychological, educational and environmental needs of patient/significant others when administering or explaining care.