Appeals & Grievances Case Manager (California)

Immediate need for a talented Appeals & Grievances Case Manager (California). This is a 06+months contract opportunity with long-term potential and is located in Los Angeles, CA (Remote). Job ID:26-31017 Pay Range: $27 - $31/hour. Traveler benefits as per agency package. (Benefits vary by vendor and assignment.) Key Requirements and Technology Experience: 5+ years of Appeals & Grievances experience within a Health Plan or Managed Care organization Experience handling: Member Appeals Provider Appeals Authorization Appeals Benefit Determinations CMS DMHC NCQA Medi-Cal Commercial Health Plans Experience reviewing medical records and clinical documentation 2+ years experience in Appeals, Grievances, Utilization Management, or Care Coordination in a health plan or TPA. Strong understanding of CMS, DMHC, and NCQA regulatory standards. Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. #J-18808-Ljbffr Pyramid Consulting, Inc