L.A. Care Health Plan is the nation’s largest publicly operated health plan serving more than 2 million members with a mission to provide access to quality health care for vulnerable and low-income communities in Los Angeles County
Job Summary
L.A. Care Health Plan is the nation’s largest publicly operated health plan serving more than 2 million members with a mission to provide access to quality health care for vulnerable and low-income communities in Los Angeles County.
The Lead Customer Solution Center Appeals and Grievances RN is responsible for overseeing complex clinical appeals and grievances, ensuring compliance with regulatory guidelines, mentoring staff, and improving customer service outcomes.
L.A. Care offers a wide range of benefits including Paid Time Off, Tuition Reimbursement, Retirement Plans, Medical, Dental and Vision coverage, Wellness Programs, and Volunteer Time Off.
Matching Summary
L.A. Care Health Plan is the nation’s largest publicly operated health plan serving more than 2 million members with a mission to provide access to quality health care for vulnerable and 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 management
regulatory compliance in healthcare
medical necessity review
team leadership and mentoring
quality review and audit
conflict resolution skills
Nice-to-have
project management skills
critical thinking and problem solving
motivational and communication skills
ability to work independently and collaboratively
adaptability to changing priorities
Key Requirements
Licensed Registered Nurse (RN) California license
At least 8 years clinical appeals and grievances experience
Minimum 2 years Medicare/Medicaid managed care experience
At least 1 year leadership experience
Associate's Degree in Nursing required
Bachelor's Degree in Nursing preferred
Work Rights
Licensed Registered Nurse with California license required