Temporary Grievance & Appeals Nurse (LVN)

Temporary Coordinator - Grievance and Appeals
Rancho Cucamonga, CA

Hybrid Position: 

Assignment: 6 Months

Pay Rate: $30.72





The Grievance & Appeals Nurse is responsible for working directly with the IPAs, Hospitals, internal departments, and the grievance team to ensure grievance and appeal cases are processed per the Grievance Policy & Procedures and Department of Managed Health Care (DMHC)/ Department of Health Care Services (DHCS)/ Center for Medicare and Medicaid Services (CMS) regulations and NCQA. Coordinate care of Members in conjunction with the Member’s PCP and IPA and/ or client Team Members to provide continuous quality care and assist in the development of quality initiatives. The Grievance & Appeals Nurse serves as a resource person to client's personnel, as well as external practitioners and Providers. When designated, the Grievance and Appeals Nurse will also be responsible for triaging and assigning grievance a...