California Licensed Grievance Nurse

Job Summary

A company is looking for a Grievance & Appeals Regulatory Nurse.

Key Responsibilities

• Investigate and resolve cases related to grievances and appeals, ensuring compliance with regulatory agencies
• Coordinate member care with providers to enhance quality initiatives
• Serve as a resource for internal personnel and providers regarding grievance and appeals processes

Required Qualifications, Training, and Education

• Three or more years of experience in case management or utilization management in a managed care setting
• Experience in an HMO or managed care environment is required
• High School Diploma or GED required; Bachelor's degree in a health-related field preferred
• Possession of an active Vocational Nurse (LVN) license issued by the California Board is required
• Obtain CMS Annual Certification within six months of hire