Lead Appeals And Grievances Rn

LA Care Health Plan

Los Angeles, CA, United States
Base: $102,183.00 - $163,492.00; bonus/equity: not...
Hybrid
Clinical appeals and grievances
Medical necessity evaluation
Regulatory compliance
L.A. Care Health Plan is dedicated to providing access to quality health care for low-income communities in Los Angeles County

Job Summary

  • L.A. Care Health Plan is dedicated to providing access to quality health care for low-income communities in Los Angeles County.
  • The Lead Appeals and Grievances RN is responsible for ensuring the accurate and timely resolution of complex clinical cases while aligning with regulatory guidelines.
  • The role includes mentoring staff, conducting case audits, and contributing to process improvements to enhance member satisfaction and compliance.

Matching Summary

L.A. Care Health Plan is dedicated to providing access to quality health care for low-income communities in Los Angeles County.

Salary

Base: $102,183.00 - $163,492.00; Bonus/Equity: Not specified; Benefits: Paid Time Off, Tuition Reimbursement, Retirement Plans, Medical, Dental, Vision, Wellness Program, Volunteer Time Off

Skills & Requirements

Must-have

  • clinical appeals and grievances
  • medical necessity evaluation
  • regulatory compliance
  • team leadership
  • case audits
  • customer service improvement

Nice-to-have

  • project management skills
  • acute clinical experience
  • process improvement initiatives

Key Requirements

  • Associate's Degree in Nursing
  • 8 years of clinical appeals and grievances experience
  • 2 years in Medicare/Medicaid managed care environment
  • 1 year of leading a process, program, or staff
  • Active California RN License

Work Rights

Must have US citizenship

Tailored Resume

Cover Letter