Job Description

Please find below the details:

Position: Grievance & Appeals Nurse Specialist

Location: Onsite – Orange County, CA (Remote applicants MUST live in Southern California)

Duration: 6 months (Possibilities of extensions/conversion)

Shift: Day 5x8-Hour

Schedule : Monday to Friday, 8:00 a.m. – 5:00 p.m.

Job Summary:

We are currently seeking a Grievance & Appeals Nurse Specialist for a full-time temporary opportunity within a mission-driven healthcare organization. This is an excellent role for a licensed and experienced nursing professional looking to apply their clinical expertise in the areas of appeals, grievances, and medical review .

Key Responsibilities:

• Review clinical cases for medical necessity and regulatory compliance
• Prepare summaries and documentation for state hearings
• Coordinate and manage medical appeals and grievance processes
• Draft resolution letters and represent the organization during hearings
• Work closely with internal departments, physicians, and external stakeholders

Requirements:

• Active LVN license in the state of California (Required)
• Minimum 5 years of experience in healthcare or managed care (e.g., utilization review, quality management, appeals)
• Strong clinical judgment and written communication skills
• RN license preferred but not required
• Bilingual in a threshold language is a plus (Arabic, Chinese, Farsi, Korean, Russian, Spanish, Vietnamese)

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