Regulatory Grievance & Appeals Nurse - Hybrid

Alura Workforce Solutions; Rancho Cucamonga (CA); Hybrid; USD 42,319 - 47,403; Full time

Job summary

A healthcare services provider is seeking a Grievance and Appeals Nurse-LVN in Rancho Cucamonga, CA. This role involves investigating and resolving regulatory cases, ensuring compliance, and coordinating member care. Candidates must possess strong communication skills, knowledge of health plan regulations, and critical thinking abilities. The position offers a hybrid work schedule and a competitive salary.

Qualifications

• Must have a valid California Driver's License.
• Knowledge of relevant laws and regulations.
• Ability to generate written correspondence accurately.

Responsibilities

• Process all incoming DMHC, DHCS and CMS regulatory cases.
• Act as primary contact between health plan and regulatory agencies.
• Review Member appeals and make appropriate determinations.

Skills

Excellent written and verbal communication skills

Critical thinking

Attention to detail

Problem-solving capability

Tools

Microcomputer applications

Job description

A healthcare services provider is seeking a Grievance and Appeals Nurse-LVN in Rancho Cucamonga, CA. This role involves investigating and resolving regulatory cases, ensuring compliance, and coordinating member care. Candidates must possess strong communication skills, knowledge of health plan regulations, and critical thinking abilities. The position offers a hybrid work schedule and a competitive salary.