Grievance & Appeals Nurse (LVN)

Grievance & Appeals Nurse (LVN) Location: Rancho Cucamonga, CA Hourly Rate: $28.25–$30.25 Requirements: Must have (2) years or more of case management, experience in an HMO or managed care setting is preferred. HS diploma or GED is required, AA from an accredited institution is preferred. Must have possession of an active, unrestricted and unencumbered Vocation Nurse (LVY) license issued by the California Board of Vocation Nursing and Psychiatric Technicians. 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 CMS and IEHP Outside agencies and resources such as CCS, CMS, DMHC, or DHCS Regulatory guidelines surrounding grievances and appeals per CMS, 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 escalation issues as identified, following established protocols Maintain a positive attitude and ability to work in a team setting #J-18808-Ljbffr