Medical Management Nurse Analyst

Australia-Employment; Fresno (CA); On-site; USD 44,000 - 48,000; Full time

Benefits offered by this job

Weekly pay

Health benefits

401(k) offered during contract

Contract-to-hire potential

Monday–Friday schedule

Job summary

Jobot in Fresno, CA seeks a Medical Management Nurse Analyst to support Appeals & Grievances, audits, and quality initiatives in a managed care setting. The role requires an RN or LVN with at least 2 years of healthcare experience and strong analytical skills.

It is a contract role with potential for contract-to-hire, Monday–Friday, on-site, with weekly pay and benefits. The ideal candidate will handle case tracking, data reconciliation, and regulatory audit prep while collaborating with

Qualifications

• Active California RN or LVN license required.
• Minimum 2 years of healthcare experience.
• Managed care experience preferred.
• Experience with Appeals & Grievances, Utilization Management, Medical Management, and related audits preferred.

Responsibilities

• Review and support Appeals & Grievances activities and case tracking.
• Maintain and reconcile databases, reports, and tracking logs.
• Gather, monitor, and analyze clinical and operational reports.
• Support oversight audits and quality improvement initiatives.
• Prepare audit summaries and assist with corrective action plan tracking.
• Participate in HEDIS, utilization management, and compliance projects.
• Ensure documentation accuracy and audit readiness.

Skills

Analytical thinking

Problem-solving

Communication skills

Organizational skills

Multitasking

Education

Active California RN or LVN license

Tools

Microsoft Office

Job description

Medical Management Nurse Analyst

$32 - $35 per hour | Fresno, CA | On-site | Consulting

Competitive Weekly Pay + Health Benefits, 401(k), and Potential Temp-to-Hire Opportunity!

A bit about us:

A respected managed care organization dedicated to improving healthcare outcomes through quality-driven programs, member-focused services, and collaborative partnerships across Central California. Committed to regulatory excellence and advancing the health of the communities it serves.

Job Title: Medical Management Nurse Analyst

Compensation: $32.00 - $35.00/hour

Location: Fresno, CA

Schedule: Monday-Friday, 8:00 AM - 5:00 PM

Type: Contract with potential for Contract-to-Hire

Why join us?

• Competitive hourly compensation paid weekly
• Health benefits and 401k offered during the contract period
• Potential for contract to hire
• Monday-Friday schedule (no weekends)
• Collaborative and supportive team environment
• Opportunity to expand managed care experience
• Meaningful work supporting healthcare services throughout the Central Valley

Job Details

We are seeking a Medical Management Nurse Analyst to support Appeals & Grievances activities, audit readiness, compliance initiatives, quality improvement programs, and healthcare reporting within a managed care environment. The ideal candidate is an RN or LVN with managed care experience, strong analytical abilities, and a collaborative approach to teamwork.

Responsibilities:

• Review and support Appeals & Grievances activities and case tracking.
• Maintain and reconcile databases, reports, and tracking logs.
• Gather, monitor, and analyze clinical and operational reports.
• Support oversight audits and quality improvement initiatives.
• Assist with preparation for DHCS, DMHC, NCQA, and other regulatory audits.
• Prepare audit summaries and assist with corrective action plan tracking.
• Participate in HEDIS, utilization management, quality improvement, and compliance-related projects.
• Assist with preparation of required clinical and operational reports.
• Ensure documentation accuracy and audit readiness.
• Collaborate with internal departments and external healthcare stakeholders.

Qualifications:

• Active California RN or LVN license required.
• Minimum 2 years of healthcare experience.
• Managed care experience strongly preferred.
• Experience with Appeals & Grievances, Utilization Management, Medical Management, Quality Improvement, Healthcare Compliance, Clinical Audits, Regulatory Audits, HEDIS, NCQA, Medi-Cal, or related managed care programs preferred.
• Strong analytical and problem-solving abilities.
• Excellent communication and organizational skills.
• Proficiency with Microsoft Office, including Excel, Word, Outlook, and PowerPoint.
• Ability to manage multiple priorities and work independently.
• Team-oriented mindset with strong interpersonal skills.
• Dependable, professional, and comfortable working within a small-office culture.

Jobot is an Equal Opportunity Employer. We provide an inclusive work environment that celebrates diversity and all qualified candidates receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity, religion, national origin, age (40 and over), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. Jobot also prohibits harassment of applicants or employees based on any of these protected categories. It is Jobot’s policy to comply with all applicable federal, state and local laws respecting consideration of unemployment status in making hiring decisions.