HealthCare Support
Grievance and Appeals Nurse
HealthCare Support, Rancho Cucamonga, California, United States, 91739
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 completeM-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 GEDClear and active LVN license in CA2+ years of Case Management, Grievances and Appeals, and/or Utilization Management from an MCO settingMust have a valid California Driver's License.Knowledge of:
Medi-Cal and Medicare benefits/regulationsClinical 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 degreeHMO experience
Benefits for Grievance and Appeals Nurse - Hybrid:
Immediate enrollment in Health InsuranceDental InsuranceLife InsuranceEmployee Assistance Program (EAP)Access to Investment AccountsCareer and educational tools within our Ingenovis ACT (Advocacy) Program
Pay Details: $31 an hour flat rate
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 dennis.lorence@healthcaresupport.com 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
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 completeM-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 GEDClear and active LVN license in CA2+ years of Case Management, Grievances and Appeals, and/or Utilization Management from an MCO settingMust have a valid California Driver's License.Knowledge of:
Medi-Cal and Medicare benefits/regulationsClinical 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 degreeHMO experience
Benefits for Grievance and Appeals Nurse - Hybrid:
Immediate enrollment in Health InsuranceDental InsuranceLife InsuranceEmployee Assistance Program (EAP)Access to Investment AccountsCareer and educational tools within our Ingenovis ACT (Advocacy) Program
Pay Details: $31 an hour flat rate
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 dennis.lorence@healthcaresupport.com 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