Grievance & Appeals Nurse Specialist - State Hearing Expert

HealthCare Talent; Orange (CA); On-site; USD 80,000 - 100,000; Full time

Benefits offered by this job

Competitive compensation

Excellent benefits package

Opportunities for advancement

Job summary

A healthcare staffing firm is seeking a Grievance & Appeals Nurse Specialist in California. The ideal candidate will manage departmental activities, ensuring compliance with health plan policies and regulations. Responsibilities include preparing clinical reviews, overseeing State Hearing cases, and training staff on procedures. A current RN or LVN license and 5 years of healthcare experience are required. The role offers competitive compensation and opportunities for advancement.

Qualifications

• Analyzing and completing written summaries on clinical cases.
• Conducting research on standards of practice and regulations.
• Training staff on GARS procedures and requirements.

Responsibilities

• Preparing clinical reviews and monitoring cases for regulatory compliance.
• Ensuring integrity of departmental database.
• Preparing position statements for State Fair Hearings.

Skills

Strong interpersonal skills

Strong verbal communication skills

Strong written communication skills

Problem solving skills

Ability to analyze clinical cases

Education

Current RN or LVN License in California

5 years of healthcare experience

Tools

MS Office suite

Job description

A healthcare staffing firm is seeking a Grievance & Appeals Nurse Specialist in California. The ideal candidate will manage departmental activities, ensuring compliance with health plan policies and regulations. Responsibilities include preparing clinical reviews, overseeing State Hearing cases, and training staff on procedures. A current RN or LVN license and 5 years of healthcare experience are required. The role offers competitive compensation and opportunities for advancement.