California Licensed Grievance Nurse

Job Summary

A company is looking for a Grievance and Appeals Nurse.

Key Responsibilities:

• Conduct investigations and clinical reviews of member grievances and appeals
• Prepare and distribute case summaries and recommendations for medical reviewers
• Collaborate with internal departments and external partners to ensure accuracy and compliance of appeal-related documentation

Required Qualifications:

• Active California LVN license in good standing
• Strong clinical skills as defined by California LVN scope of practice
• Ability to read, interpret, and apply clinical information and regulatory materials
• Proficient in Microsoft Word, Excel, and Outlook
• Demonstrated ability to work independently and as part of a team