Working Nurse
Lead Customer Solution Center Appeals and Grievances RN
Working Nurse, Los Angeles, California, United States, 90079
Lead Customer Solution Center Appeals and Grievances RN
Location:
Los Angeles, 90017 Job ID:
12606 Employment type:
Full Time Pay Range:
$102,183.00 (Min.) - $132,838.00 (Mid.) - $163,492.00 (Max.)
Apply at the
Working Nurse
website.
The Lead Customer Solution Center Appeals and Grievances RN is responsible for assisting with the development of a successful and cohesive Appeals and Grievance (A&G) clinical unit. This position is responsible for the quality review of complex and/or escalated clinical A&G cases for all lines of business (LOB). The Lead will assist in identifying areas of improvement in increasing positive audit outcomes and improved customer service to L.A. Care’s (LAC) membership.
This position will ensure the effective investigation and resolution of clinical grievances, appeals, complaints, and complex issues in alignment with L.A. Care policy and procedures along with all relevant regulatory guidelines. Leads and works closely with the assigned team daily. The Lead will mentor, coach, and may provide feedback to management on performance of staff and ensure team effectiveness and project completion.
Required Qualifications
At least 8 years of clinical appeals and grievances experience in a managed care, utilization management, and/or case management setting.
At least 2 years in Medicare/Medicaid in a managed care/health plan environment.
At least 1 year of leading a process, program, or staff experience.
Preferred Qualifications
Clinical acute experience.
About the Hospital As the nation's largest publicly‑operated health plan, we have a great responsibility to the communities we serve, and our employees play an essential role in ensuring we meet those needs.
Why Join Us? Opportunity. Amazing co‑workers. A supportive management team. Great compensation and benefits. Camaraderie and a true sense of mission. If you want a career that truly contributes to the good of all, join us as we work towards a healthier L.A.
#J-18808-Ljbffr
Los Angeles, 90017 Job ID:
12606 Employment type:
Full Time Pay Range:
$102,183.00 (Min.) - $132,838.00 (Mid.) - $163,492.00 (Max.)
Apply at the
Working Nurse
website.
The Lead Customer Solution Center Appeals and Grievances RN is responsible for assisting with the development of a successful and cohesive Appeals and Grievance (A&G) clinical unit. This position is responsible for the quality review of complex and/or escalated clinical A&G cases for all lines of business (LOB). The Lead will assist in identifying areas of improvement in increasing positive audit outcomes and improved customer service to L.A. Care’s (LAC) membership.
This position will ensure the effective investigation and resolution of clinical grievances, appeals, complaints, and complex issues in alignment with L.A. Care policy and procedures along with all relevant regulatory guidelines. Leads and works closely with the assigned team daily. The Lead will mentor, coach, and may provide feedback to management on performance of staff and ensure team effectiveness and project completion.
Required Qualifications
At least 8 years of clinical appeals and grievances experience in a managed care, utilization management, and/or case management setting.
At least 2 years in Medicare/Medicaid in a managed care/health plan environment.
At least 1 year of leading a process, program, or staff experience.
Preferred Qualifications
Clinical acute experience.
About the Hospital As the nation's largest publicly‑operated health plan, we have a great responsibility to the communities we serve, and our employees play an essential role in ensuring we meet those needs.
Why Join Us? Opportunity. Amazing co‑workers. A supportive management team. Great compensation and benefits. Camaraderie and a true sense of mission. If you want a career that truly contributes to the good of all, join us as we work towards a healthier L.A.
#J-18808-Ljbffr