Customer Solution Center Appeals and Grievances Nurse Specialist RN II
The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II provides direct assistance to member's 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.
- Associate's Degree in Nursing
- Bachelor's Degree in Nursing
- At least 5-7 years of experience in Clinical Nursing and 2 years in Medicare/ Medicaid in a managed care/ health plan environment.
- Good working knowledge of regulatory requirements/standards.
About the Hospital
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.