California Licensed Grievance Nurse

A company is looking for a Grievance & Appeals Nurse, RN (Remote). Key Responsibilities Process Grievance and Appeal cases in compliance with relevant regulations and policies Coordinate care with members' PCPs and internal teams to ensure quality of care Act as a resource for internal and external practitioners and manage case triaging and assignment Required Qualifications, Training, and Education Two or more years of RN experience in case management or utilization management Two or more years of clinical nursing experience in a hands-on patient care setting Active, unrestricted Registered Nurse (RN) license issued by the California Board of Registered Nursing Associate's degree in nursing from an accredited institution required; Bachelor's degree preferred Experience in managed care settings preferred

Apr 21, 2025 - 19:49

A company is looking for a Grievance & Appeals Nurse, RN (Remote). Key Responsibilities Process Grievance and Appeal cases in compliance with relevant regulations and policies Coordinate care with members' PCPs and internal teams to ensure quality of care Act as a resource for internal and external practitioners and manage case triaging and assignment Required Qualifications, Training, and Education Two or more years of RN experience in case management or utilization management Two or more years of clinical nursing experience in a hands-on patient care setting Active, unrestricted Registered Nurse (RN) license issued by the California Board of Registered Nursing Associate's degree in nursing from an accredited institution required; Bachelor's degree preferred Experience in managed care settings preferred