Appeals and Grievances - RN, Senior- Medicare

The Medicare Appeals and Grievances RN Senior will perform clinical review of member appeals and grievances, utilizing CMS and/or DHCS approved guidelines, and has understanding and knowledge of the Medicare Provider Manual, National Coverage Determination (NCD) guidelines, and other nationally recognized sources. The role requires clinical expertise, strong communication skills, and collaboration with business partners.

Requirements

• 3+ years of experience as a Registered Nurse (RN)
• Ability to understand and apply regulatory requirements and clinical guidelines
• Strong clinical and critical thinking skills
• Excellent communication and collaboration skills
• Knowledge of Medicare, Medi-Cal, and other national coverage determinations

Benefits

• Medical, dental, and vision insurance
• Retirement plan
• Paid time off
• Holiday pay
• Life insurance