RN Job

Customer Solution Center Appeals and Grievances Nurse Specialist RN II

Full Time
Pay Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.)
Job ID: 10150
Los Angeles, 90017

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. 

Qualifications

Education Required

  • Associate's Degree in Nursing

Education Preferred

  • Bachelor's Degree in Nursing

Experience Required

  • 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.

View Job

 

Additional Jobs at L.A. Care Health Plan

Facility Site Review Nurse Specialist RN II

Full Time
Pay Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.)
Job ID: 10424
Los Angeles, 90017

The Facility Site Review (FSR) Nurse Specialist RN II conducts face-to-face...

View Job

Utilization Management Admissions Liaison RN II

Full Time
Pay Range: $88,854.00 (Min.) - $115,509.00 (Mid.) - $142,166.00 (Max.)
Job ID: 10546
Los Angeles, 90017

The Utilization Management (UM) Admissions Liaison RN II is primarily...

View Job

Supervisor, Care Management

Full Time
Pay Range: $102,183.00 (Min.) - $132,838.00 (Mid.) - $163,492.00 (Max.)
Job ID: 10748
Los Angeles, 90017

The Supervisor of Care Management (CM) is responsible for monitoring the CM...

View Job

Hiring Now

Experience the Digital Flip Mag

Flip through the pages of the latest Working Nurse magazine on your device.