Nurse Analyst, Medical Management & Compliance (On-site)

CalViva Health; Fresno (CA); On-site; USD 50,000 - 61,000; Full time

Job summary

CalViva Health is seeking a Medical Management Nurse Analyst - Administrative to join the on-site Medical Management team in Fresno, CA. The role focuses on reviewing Appeals & Grievances, maintaining tracking databases, and supporting oversight audits with accuracy and regulatory compliance.

The ideal candidate has a nursing license in California, at least two years in healthcare, and strong data analysis skills.

Qualifications

• Completion of an accredited nursing program.
• Current California nursing license (RN or LVN).
• Minimum of two years’ experience in healthcare environment.
• Health Care Quality Improvement, data analysis, and/or auditing experience.

Responsibilities

• Review Appeals & Grievances cases and support audits.
• Maintain tracking databases and assist with oversight audits.
• Assist with external audits (DHCS, DMHC, NCQA) documentation.
• Prepare audit summaries and corrective action plans.
• Participate in HEDIS projects and other QA/UM activities.
• Prepare CalViva clinical reports.

Skills

Healthcare data analysis

Auditing

Microsoft Office proficiency

Data reporting

Independent work

Education

Nursing program completion

Tools

Word

Excel

PowerPoint

Access

Outlook

Job description

CalViva Health is seeking a Medical Management Nurse Analyst - Administrative to join the on-site Medical Management team in Fresno, CA. The role focuses on reviewing Appeals & Grievances, maintaining tracking databases, and supporting oversight audits with accuracy and regulatory compliance.

The ideal candidate has a nursing license in California, at least two years in healthcare, and strong data analysis skills.