Grievance & Appeals Nurse Specialist
The Judge Group Inc.

Job Info

---

Location: Orange, CA
Salary: $40.00 USD Hourly - $45.00 USD Hourly
Description: The Judge Group is currently seeking a Grievance & Appeals Nurse Specialist for a great client in Orange, CA! If you would be interested to apply, please send your most updated resume to me at jmaybrier@judge.com!

This job will have the following responsibilities:

• Manage the company's medical appeals and state hearing reviews for all lines of business, including handling expedited and standard requests.
• Ensure appeals and state hearing requests are processed in accordance with regulations, compliance standards and policies and procedures.
• 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.
• Articulate disputes to the Administrative Law Judge hearing the case
• Responsible for creating and reviewing resolution letters for appropriateness of clinical criteria and regulatory requirements.
  

Qualifications & Requirements:

• High School diploma required.
• Active Licensed Vocational Nurse (LVN) license to practice in the state of California required.
• 5 years of health care/managed care experience required. Preferably in the following related areas of responsibility: Grievances and Appeals, Utilization Management and/or Quality Management.
• An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying.

Preferred Qualifications:

• Active Registered Nurse (RN) license to practice in the state of California.
• Bilingual in English and in one of these languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese).

If you are interested or know anyone that might be, you can reach Jacob at jmaybrier@judge.com! Not what you are looking for? Let's connect and see what other opportunities we have available for you!

Contact: jmaybrier@judge.com

This job and many more are available through The Judge Group. Find us on the web at www.judge.com

This job has expired.