Medical Management Nurse Analyst

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

Benefits offered by this job

Health benefits

401k

Job summary

LeoForce in Fresno, CA is seeking a Medical Management Nurse Analyst to support Appeals & Grievances, audit readiness, and quality improvement initiatives within a managed care setting.

The ideal candidate is an RN or LVN with managed care experience, strong analytical skills, and the ability to collaborate across departments in a small-office environment. This is a contract role with strong potential for permanent hire, offering $32.00-$35.00/hour on-site in Fresno.

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.

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.

Skills

RN or LVN license

Analytical skills

Collaboration

Microsoft Office

Tools

Microsoft Office

Job description

Medical Management Nurse Analyst

Fresno, CA, US

6919904

3 days ago

Job Description

Experience: Manager

Salary: $32 - $35 per hour

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.

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 strong potential for permanent 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