Temporary Grievance & Appeals Nurse (LVN)

Temporary Grievance & Appeals Nurse (LVN)

Work location: Rancho Cucamonga, CA 91701 Payrate: $30.72 /HR Duration: Six-month Assignment

Responsibilities

Qualifications:

• Two (2) years or more case management, utilization management in managed care setting or related experience in a health care delivery setting
• Experience in an HMO or experience in managed care setting preferred
• High school diploma or GED required
• Associate's degree from an accredited institution preferred
• Minimum possession of an active, unrestricted, and unencumbered Vocational Nurse (LVN) license issued by the California Board of Vocational Nursing and Psychiatric Technicians required

Key Qualifications

• Must have a valid California Driver's License
• Working knowledge and understanding of:
• Member and Provider legal rights to access the grievance and appeals resolution process, within the respective Provider Organization, DHCS, DMHC, and Client and IEHP
• Outside agencies and resources such as CCS, Client, DMHC, or DHCS
• Regulatory guidelines surrounding grievances and appeals per Client, DHCS, and DMHC and NCQA
• Microcomputer applications: spreadsheet, database, and word processing. Excellent written and verbal communication skills
• Proven ability to:
• Demonstrate critical thinking and strong problem-solving capability
• Demonstrate a commitment to incorporate LEAN principles into daily work
• Possess strong attention to detail
• Prioritize work to ensure adherence to project deadlines
• Effectively escalate issues as identified, following established protocols
• Maintain a positive attitude and ability to work in a team setting