What are the responsibilities and job description for the Appeals and Grievance Specialist (Remote) - Start ASAP position at InfiCare?
Job Title: Appeals and Grievance Specialist (Onsite)
Assignment Length: 6 Months
Location: Remote (must reside in Southern CA)
Pay Rate: $30.72/hour
Job Summary:
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's 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 our 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 and appeals cases to ensure timeliness and regulatory requirements are met.
Requirements:
- Two (2) years or more case management, utilization management in managed care setting or related experience in a health care delivery setting
- Experience in an HMO or experience in managed care setting preferred
- High school diploma or GED required
- Associate’s degree from an accredited institution preferred
- Minimum possession of an active, unrestricted, and unencumbered Vocational Nurse (LVN) license issued by the California Board of Vocational Nursing and Psychiatric Technicians required
- Must have a valid California Driver's License
Who We Are?
Since 2001, InfiCare has been providing contract and direct hire staffing services to its clients across the US. InfiCare Health awarded the Gold Seal Accreditation from The Joint Commission.
Reference links below are company websites:
https://inficarehealth.com/press-releases/
https://www.greatplacetowork.com/certified-company/7037388
https://www.inc.com/profile/inficare
#IND3
Job Type: Contract
Pay: $30.72 per hour
Education:
- High school or equivalent (Required)
Experience:
- case management and utilization management: 2 years (Required)
License/Certification:
- LVN (Required)
Work Location: Remote
Salary : $31