California Licensed Clinical Grievances Nurse

Job Summary

To support a growing healthcare initiative, the part-time California Licensed Clinical Grievances Nurse will review incoming retrospective and current cases to ensure appropriate care is provided, working remotely during PST hours from Monday to Friday, 8 am to 5 pm.

Key responsibilities:

• Perform clinical assessments of healthcare services for appropriateness and compliance with grievance requirements
• Document case reviews and provide rationale for severity levels and any Improvement Action Plans
• Facilitate discussions with healthcare providers and members to gather additional clinical information

Required qualifications:

• Current, unrestricted RN license in California
• 3+ years of RN experience, including recent clinical experience in an inpatient or acute setting
• Proficiency in computer skills, including Microsoft Suite and clinical platforms
• Strong clinical documentation and critical thinking skills
• Designated workspace with secure high-speed internet access