Medical Management Nurse Analyst

Leoforce; Fresno (CA); In loco; USD 44.000 - 48.000; Tempo pieno

Vantaggi offerti da questo lavoro

Health benefits

401k

Potential for permanent hire

Weekday schedule (Mon-Fri)

Descrizione del lavoro

Leoforce is seeking a Medical Management Nurse Analyst in Fresno, CA. The role focuses on supporting Appeals & Grievances activities, audit readiness, quality improvement programs, and healthcare reporting within a managed care setting.

The ideal candidate is an RN or LVN with managed care experience and strong analytical skills. The position involves collaboration with internal teams and external healthcare stakeholders, with a Monday–Friday schedule, contract type with strong potential for

Competenze

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

Mansioni

• 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.

Conoscenze

Analytical abilities

Communication skills

Teamwork

Independent work

Multi-tasking

MS Office

Formazione

California RN or LVN license

Strumenti

Excel

Word

PowerPoint

Outlook

Descrizione del lavoro

Job Description

Medical Management Nurse Analyst

Fresno,CA, US

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