What are the responsibilities and job description for the Appeals and Grievances Nurse Specialist RN II position at Working Nurse?
RN Job
Appeals and Grievances Nurse Specialist RN II
Shift
Full Time
Pay Range
$88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.)
Job ID
13048
Location
Los Angeles, 90017
Apply at Website
Job Description
The Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II provides direct assistance to members with health care access or benefit coordination issues, ensuring that clinical grievances, complaints and complex issues are investigated and resolved to the member's satisfaction in a manner consistent with L.A. Care, Centers of Medicare and Medicaid Services (CMS) and regulatory guidelines.
Benefit coordination may involve coordinating multiple L.A. Care products, Fee for services (FFS) Medi-Cal/Medicare, or commercial insurance.
Qualifications
Education Required:
As the nation's largest publicly-operated health plan, we have a great responsibility to the communities we serve, and our employees play an essential role in ensuring we meet those needs.
Why Join Us?
Opportunity. Amazing co-workers. A supportive management team. Great compensation and benefits. Camaraderie and a true sense of mission. If you want a career that truly contributes to the good of all, join us as we work towards a healthier L.A.
Appeals and Grievances Nurse Specialist RN II
Shift
Full Time
Pay Range
$88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.)
Job ID
13048
Location
Los Angeles, 90017
Apply at Website
Job Description
The Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II provides direct assistance to members with health care access or benefit coordination issues, ensuring that clinical grievances, complaints and complex issues are investigated and resolved to the member's satisfaction in a manner consistent with L.A. Care, Centers of Medicare and Medicaid Services (CMS) and regulatory guidelines.
Benefit coordination may involve coordinating multiple L.A. Care products, Fee for services (FFS) Medi-Cal/Medicare, or commercial insurance.
Qualifications
Education Required:
- Associate's Degree in Nursing
- Bachelor's Degree in Nursing
- At least 5 years of experience in Clinical RN.
- At least 2 years in Medicare/ Medicaid in a managed care/ health plan environment.
As the nation's largest publicly-operated health plan, we have a great responsibility to the communities we serve, and our employees play an essential role in ensuring we meet those needs.
Why Join Us?
Opportunity. Amazing co-workers. A supportive management team. Great compensation and benefits. Camaraderie and a true sense of mission. If you want a career that truly contributes to the good of all, join us as we work towards a healthier L.A.
Salary : $88,854