Grievance and Appeals Nurse Specialist

HealthCare Support is actively seeking a Grievance and Appeals Nurse Specialist to fill an opening with a Fortune top 25 Managed Care Company in Orange, CA.

This role is ONSITE/IN-OFFICE M-F working an 8 hour shift between the hours of 7am-8pm.

6 month contract only – you may have the possibility to be able to apply to FTE positions if they open up.

Daily Responsibilities for Grievance and Appeals Nurse Specialist:

• Participates in managing medical appeals and state hearing reviews for all lines of business, including handling expedited and standard requests.
• The incumbent will ensure appeals and state hearing requests are processed in accordance with regulations, compliance standards and policies and procedures.
• The incumbent will investigate and prepare case narratives and statements of position based on clinical information, benefits and applicable regulations related to member or provider disputes of decisions.
• The incumbent will be responsible for creating and reviewing resolution letters for appropriateness of clinical criteria and regulatory requirements.
  
  
  

Required Qualifications for Grievance and Appeals Nurse Specialist:

• Associates Degree in Nursing
• LVN or RN license in CA
• 5 years of health care/managed care experience required
• 1+ years of Grievances and Appeals experience
• Computer Skills - Word, Outlook, Excel, PowerPoint
  
  
  

Preferred Qualifications for Grievance and Appeals Nurse Specialist:

• Bachelors preferred
• Experience in the following related areas of responsibility: Grievances and Appeals, Utilization Management and/or Quality Management.
• Bilingual
  
  
  

Benefits for Grievance and Appeals Nurse Specialist:

• Immediate enrollment in Health Insurance
• Dental Insurance
• Life Insurance
• Employee Assistance Program (EAP)
• Access to Investment Accounts
• Career and educational tools within our Ingenovis ACT (Advocacy) Program
  
  
  

Pay Details: $43.66 to $69.86 an hour

Interested in being considered?

If you are interested in applying to this position, please click Apply Now for immediate consideration.

For additional consideration, please email a copy of your resume to [email protected] with your phone number, the position title and location, and our recruiters will reach out.

Healthcare Support Staffing, LLC. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.

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