Lead Customer Solution Center Appeals and Grievances RN

Lead Appeals and Grievances RN responsible for assisting in the development of a successful and cohesive clinical appeals and grievances unit, reviewing complex cases, and mentoring staff. Ensures effective investigation and resolution of grievances, appeals, complaints, and complex issues in alignment with L.A. Care policy and procedures.

Requirements

• 8 years of clinical appeals and grievances experience in a managed care, utilization management and/or case management setting
• 2 years in Medicare/Medicaid in a managed care/health plan environment
• 1 year of leading a process, program, or staff experience

Benefits

• Paid Time Off (PTO)
• Tuition Reimbursement
• Retirement Plans
• Medical, Dental and Vision
• Wellness Program
• Volunteer Time Off (VTO)