HealthCare Support is actively seeking a LVN Grievance and Appeals Nurse to fill an opening with a top Managed Care Company in Rancho Cucamonga, CA. This is a Remote role, but training must be completed onsite in Rancho Cucamonga, CA. 6 month contract, eligible to apply to internal positions after 6 month contract is complete.
Daily Responsibilities for LVN Grievance and Appeals Nurse:
- The Grievance & Appeals Nurse is responsible for working directly with the IPAs, Hospitals, internal departments, and the grievance team to ensure grievance and appeal cases are processed per the Grievance Policy & Procedures and Department of Managed Health Care (DMHC)/ Department of Health Care Services (DHCS)/ Center for Medicare and Medicaid Services (CMS) regulations and NCQA.
- Coordinate care of Members in conjunction with the Member’s PCP and IPA and/ or
- Team Members to provide continuous quality care and assist in the development of quality initiatives. The Grievance & Appeals Nurse serves as a resource person to company personnel, as well as external practitioners and Providers.
- When designated, the Grievance and Appeals Nurse will also be responsible for triaging and assigning grievance and appeals cases to ensure timeliness and regulatory requirements are met.
Required Qualifications for LVN Grievance and Appeals Nurse:
- High school diploma or GED
- Clear and active LVN license in CA
- Must be able to lift or move up to 25 pounds – will require physical during onboarding
- 2+ years of experience with case management, utilization management in managed care setting or related experience in a health care delivery setting
- Grievance and Appeals knowledge required
- 1 year in an HMO or MCO setting preferred
- Must have a valid California Driver’s License.
Benefits for LVN Grievance and Appeals Nurse:
- 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: $30.72 an hour
Interested 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.