Appeals And Grievances Nurse Specialist Rn Ii

LA Care Health Plan

Los Angeles, CA, US
Base: $88,854.00 - $142,166.00; bonus/equity: not ...
On-site
Clinical rn experience required
Medicare/medicaid managed care knowledge
Regulatory compliance investigation skills
The role involves investigating and resolving complex clinical grievances and appeals for over 2 million members in Los Angeles County

Job Summary

  • The role involves investigating and resolving complex clinical grievances and appeals for over 2 million members in Los Angeles County.
  • Candidates must possess at least 5 years of clinical RN experience and 2 years in a Medicare or Medicaid managed care environment.
  • The position offers a hybrid remote schedule with flexibility for after-hours work and on-call duties during critical situations.

Matching Summary

The role involves investigating and resolving complex clinical grievances and appeals for over 2 million members in Los Angeles County.

Salary

Base: $88,854.00 - $142,166.00; Bonus/Equity: Not specified; Benefits: PTO, Tuition Reimbursement, Retirement Plans, Medical/Dental/Vision

Skills & Requirements

Must-have

  • Clinical RN experience required
  • Medicare/Medicaid managed care knowledge
  • Regulatory compliance investigation skills
  • Expedited case resolution within 72 hours
  • Medical records coordination with providers

Nice-to-have

  • Excellent interpersonal communication skills
  • Team player with strong organization
  • Adaptability to changing priorities
  • Experience with inter-rater reliability training

Key Requirements

  • Active California Registered Nurse (RN) License
  • Associate's Degree in Nursing (Required)
  • Bachelor's Degree in Nursing (Preferred)
  • 5 years Clinical RN experience
  • 2 years Medicare/Medicaid managed care experience

Work Rights

Not specified

Tailored Resume

Cover Letter