Registered Nurse - Appeals and Grievance Specialist Job

REGISTERED NURSE APPEALS AND GRIEVANCE NURSE SPECIALIST needed for a CONTRACT opportunity with Yoh's client located in Los Angeles, CA.

Top Skills Should You Possess:
- Registered Nurse (State of California)
- Appeals and Grievance in a HMO Setting
- Utilizing using CMS and NCQA standards

What You'll Be Doing:
- Assist member's with health care access or benefit coordination issues
- Ensure that all clinical grievances, complaints and complex issues are investigated
- Handling FFS Medi-Cal/Medicare and commercial insurance

What You Need to Bring to the Table:
- Registered Nurse Licensure in State of California (Active and in Good Standing)
- Associates Degree in Nursing from Accredited School
- Three to five (3-5) years of Appeals and Grievance in a Managed Care Setting
- At least two (2) years of Medicare Experience
- Must have good working knowledge of regulatory requirements/standards
- Experienced in CMS and NCQA Standards
- Bonus Points! Otherwise Known As Preferred Qualifications:
- Bachelors Degree in Nursing highly desirable
- Bilingual in Spanish

OPPORTUNITY IS CALLING, APPLY NOW!

RECRUITER: Christine Mosessian

Yoh, a Daythis address is exclusively for individuals with disabilities requesting application assistance.

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