Nurse Analyst, Medical Management – Appeals & Audits

Leoforce; Fresno (CA); Sur place; USD 44 000 - 48 000; Plein temps

Avantages offerts par ce poste

Health benefits

401k

Potential for permanent hire

Weekday schedule (Mon-Fri)

Résumé du poste

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

Qualifications

• 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.

Responsabilités

• 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.

Connaissances

Analytical abilities

Communication skills

Teamwork

Independent work

Multi-tasking

MS Office

Formation

California RN or LVN license

Outils

Excel

Word

PowerPoint

Outlook

Description du poste

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