LVN Grievance and Appeals Regulatory Nurse

HealthCare Support is actively seeking a LVN Grievance and Appeals Regulatory Nurse to fill an opening with a Managed Care Company in Rancho Cucamonga, CA.

• Hybrid, after training will work from home 2 days a week/in office 3 days a week - Rancho Cucamonga, CA 91730***
  
  
  

Daily Responsibilities for LVN Grievance and Appeals Regulatory Nurse:

• 6 month contract, eligible to apply to internal positions after 6 month contract is complete
• Ability to work M-F, 8-5
• Process all incoming DMHC, DHCS and CMS regulatory cases (Consumer Complaints, Independent Medical Reviews, statement of positions, CMS complaints, etc.) and monitoring timeliness of responses for all Plan lines of business.
• Act as a primary contact between company and regulatory agencies in resolving Member grievance and appeals by maintaining positive communication and working closely with Compliance and Legal Departments in resolving Members’ complaints, grievances, and appeals.
• File Plan Grievances and Appeals / Claim Dispute / request State Fair Hearing process; distinguishing between an inquiry, a Grievance, an Appeal, a Claim Dispute, and a quality-of-care issue and know how to triage, resolve, or refer incoming calls/correspondence to appropriate personnel.
• Work closely with the Grievance and Appeals Team, with Internal Departments, and DMHC/DHCS/CMS to ensure all Member appeals are investigated, and care is coordinated appropriately.
  
  
  

Required Qualifications for LVN Grievance and Appeals Regulatory Nurse:

• High school diploma or GED (Bachelors preferred)
• Clear and active LVN license in CA
• 3 years of experience with case management, utilization management in managed care setting or related experience in a health care delivery setting
• Grievance and Appeals knowledge required
• 1 year in an HMO or MCO setting required
• Must obtain Center for Medicare and Medicaid Services (CMS) Annual Certification within six (6) months of hire
• Must have a valid California Driver's License.
  
  
  

Preferred Qualifications for LVN Grievance and Appeals Regulatory Nurse:

• Experience in either State Fair Hearing (SFH) or Appeals or Grievances
• Legal processing experience preferred
  
  
  

Benefits for LVN Grievance and Appeals Regulatory Nurse:

• 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: $34.41 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 dennis.lorence@healthcaresupport.com 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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