Registered Nurse - Grievance and Appeals Job

REGISTERED NURSE (RN), GRIEVANCES AND APPEALS needed for a CONTRACT opportunity with Yoh's client located in Torrance, CA

THE BIG PICTURE - TOP SKILLS SHOULD YOU POSSESS:

- Registered Nurse
- Utilization Management/Compliance

WHAT YOU'LL BE DOING:

- Responsible to review and/or write referral denials to assure regulatory compliance
- Educate Care Management regional departments on the regulatory requirements from all regulatory organizations (CMS, NCQA and contracted Health Plans)
- Act as a resource with regards to regulatory requirements from participating regulatory agencies
- Assist department Director with preparation for health plan and regulatory audits

WHAT YOU NEED TO BRING TO THE TABLE:

- RN or LVN license in the state of California
- Graduate from an accredited school of Nursing
- Bachelor's degree in Nursing or a professional certification requiring formal education beyond a two year degree
- Experience with referrals and denial process a MUST
- Recent clinical experience
- Utilization review/discharge planning or case management experience
- Excellent computer skills, strong writing skills required

OPPORTUNITY IS CALLING, APPLY NOW!

RECRUITER: Emi Flaherty

Yoh, a Day & Zimmermann company, is an Equal Opportunity Employer, M/F/D/V. Contact us if you are an individual with a disability and require accommodation in the application process.

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