Aroha Technologies, Inc
Grievance & Appeals Nurse Specialist - (RN/LVN)
Aroha Technologies, Inc, Orange, California, United States, 92613
Grievance & Appeals Nurse Specialist - (RN/LVN)
Temporary – Grievance & Appeals Nurse Specialist
Location: Orange, CA
Department: Grievance & Appeals
Work Arrangement: Onsite (Full Office)
Job Type: Contract
Pay Range: $53 to $65/hr (Based on experience)
Schedule: Monday – Friday | 8:00 a.m. – 5:00 p.m.
About The Role CalOptima Health is seeking a Grievance & Appeals Nurse Specialist (Temporary) to join our team. In this role, you will manage medical appeals and state hearing reviews across all lines of business, ensuring compliance with regulatory standards and organizational policies. You will investigate appeals, prepare clinical case narratives, and represent CalOptima Health’s position in state hearings. This position plays a vital role in supporting fair and timely resolution of member and provider disputes.
Responsibilities
Process expedited and standard medical appeal and state hearing requests in compliance with regulations and policies.
Investigate and prepare case narratives and statements of position based on clinical data, benefits, and applicable regulations.
Clearly present case facts and CalOptima Health’s position during Administrative Law Judge hearings.
Draft and review resolution letters to ensure compliance with clinical and regulatory standards.
Collaborate with internal teams to ensure timely, accurate, and fair resolution of appeals and grievances.
Must Have Qualifications
High School diploma required.
5 years of healthcare or managed care experience, preferably in grievances and appeals, utilization management, and/or quality management.
Equivalent combinations of education and experience may be considered.
Current unrestricted Licensed Vocational Nurse (LVN) license in California.
Preferred Qualifications
Current unrestricted Registered Nurse (RN) license in California.
Bilingual in English and one of CalOptima Health’s threshold languages (Arabic, Chinese, Farsi, Korean, Russian, Spanish, Vietnamese).
Knowledge & Abilities
Strong communication skills (oral and written) with ability to present complex information clearly.
Build and maintain positive relationships with staff, leadership, and external stakeholders.
Effective organizational, analytical, and problem‑solving skills.
Ability to work independently in a fast‑paced environment and manage multiple priorities.
Proficiency with Microsoft Office (Word, Outlook, Excel, PowerPoint) and relevant job-specific systems.
Flexibility to participate in occasional evening or weekend events.
Why Join Us At CalOptima Health, you’ll have the opportunity to make an impact by ensuring members and providers receive fair, timely, and compliant grievance and appeals support, while working in a collaborative and mission-driven environment.
Best regards, Amit Singh Sr. Healthcare Recruiter
Direct: 510-972-5969 Email: amits@arohatechnologies.com
Aroha Technologies Inc. 5000 Hopyard Rd Suite - 415 Pleasanton, CA - 94588
Seniority level Associate
Employment type Contract
Job function Health Care Provider
Industries Hospitals and Health Care
#J-18808-Ljbffr
Location: Orange, CA
Department: Grievance & Appeals
Work Arrangement: Onsite (Full Office)
Job Type: Contract
Pay Range: $53 to $65/hr (Based on experience)
Schedule: Monday – Friday | 8:00 a.m. – 5:00 p.m.
About The Role CalOptima Health is seeking a Grievance & Appeals Nurse Specialist (Temporary) to join our team. In this role, you will manage medical appeals and state hearing reviews across all lines of business, ensuring compliance with regulatory standards and organizational policies. You will investigate appeals, prepare clinical case narratives, and represent CalOptima Health’s position in state hearings. This position plays a vital role in supporting fair and timely resolution of member and provider disputes.
Responsibilities
Process expedited and standard medical appeal and state hearing requests in compliance with regulations and policies.
Investigate and prepare case narratives and statements of position based on clinical data, benefits, and applicable regulations.
Clearly present case facts and CalOptima Health’s position during Administrative Law Judge hearings.
Draft and review resolution letters to ensure compliance with clinical and regulatory standards.
Collaborate with internal teams to ensure timely, accurate, and fair resolution of appeals and grievances.
Must Have Qualifications
High School diploma required.
5 years of healthcare or managed care experience, preferably in grievances and appeals, utilization management, and/or quality management.
Equivalent combinations of education and experience may be considered.
Current unrestricted Licensed Vocational Nurse (LVN) license in California.
Preferred Qualifications
Current unrestricted Registered Nurse (RN) license in California.
Bilingual in English and one of CalOptima Health’s threshold languages (Arabic, Chinese, Farsi, Korean, Russian, Spanish, Vietnamese).
Knowledge & Abilities
Strong communication skills (oral and written) with ability to present complex information clearly.
Build and maintain positive relationships with staff, leadership, and external stakeholders.
Effective organizational, analytical, and problem‑solving skills.
Ability to work independently in a fast‑paced environment and manage multiple priorities.
Proficiency with Microsoft Office (Word, Outlook, Excel, PowerPoint) and relevant job-specific systems.
Flexibility to participate in occasional evening or weekend events.
Why Join Us At CalOptima Health, you’ll have the opportunity to make an impact by ensuring members and providers receive fair, timely, and compliant grievance and appeals support, while working in a collaborative and mission-driven environment.
Best regards, Amit Singh Sr. Healthcare Recruiter
Direct: 510-972-5969 Email: amits@arohatechnologies.com
Aroha Technologies Inc. 5000 Hopyard Rd Suite - 415 Pleasanton, CA - 94588
Seniority level Associate
Employment type Contract
Job function Health Care Provider
Industries Hospitals and Health Care
#J-18808-Ljbffr