Grievance and Appeals Nurse - Healthcare Support : Job Details

Grievance and Appeals Nurse - Hybrid HealthCare Support is actively seeking a Grievance and Appeals Nurse - Hybrid to fill an opening with a Fortune top 25 Managed Care Company in Rancho Cucamonga, CA 6 month contract, eligible to apply to internal positions after 6 month contract is complete M-F 8am-5pm. Hybrid, after training will work from home 2 days a week/in office 3 days a week Daily Responsibilities for Grievance and Appeals Nurse - Hybrid:

• Work closely with the Grievance and Appeals Team under the direction of the Grievance Nurse Leadership with Member Services, Provider Services, Compliance, Medical Services Departments, and DMHC/DHS/CMS to ensure all Member grievance issues are investigated, and care is coordinated appropriately and in adherence to Grievance and Appeals Policies and Procedures.
• Review case coding to ensure it is accurate, assist in the resolution of Member medical issues and assist with coordination of care with all practitioners, Providers and entities/agencies involved in the Member's care.
• Resolve medical grievances, in conjunction with staff, Grievance Management, and Providers, as applicable.

Required Qualifications for Grievance and Appeals Nurse - Hybrid:

• High school diploma or GED
• Clear and active LVN license in CA
• 2+ years of Case Management, Grievances and Appeals, and/or Utilization Management from an MCO setting
• Must have a valid California Driver's License.
• Knowledge of:
  • Medi-Cal and Medicare benefits/regulations
  • Clinical review processes including how to analyze and research clinical issues.
  • Appeals and grievance processes.
  • outside agencies and resources such as; CCS, CMS, DMHC, or DHCS.

Preferred Qualifications for Grievance and Appeals Nurse - Hybrid:

• Bachelor's degree
• HMO experience

Benefits for Grievance and Appeals Nurse - Hybrid:

• Immediate enrollment in Health Insurance
• Dental Insurance
• Life Insurance
• Employee Assistance Program (EAP)
• Access to Investment Accounts
• Career and educational tools within our Ingenovis ACT (Advocacy) Program

Pay Details: $31 an hour flat rateInterested in being considered? If you are interested in applying to this position, please click Apply Now for immediate consideration. For additional consideration, please email a copy of your resume to [email protected] with your phone number, the position title and location, and our recruiters will reach out. Healthcare Support Staffing, LLC. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law. #Mng #slvlvn924