Job Description
Title: Temporary Grievance & Appeals Nurse (LVN)
Work location: Rancho Cucamonga, CA 91701
Payrate: $30.72 /HR
Duration: Six-month Assignment
Requirements:
Responsibilities:
Qualifications:
Education & Requirements
Work location: Rancho Cucamonga, CA 91701
Payrate: $30.72 /HR
Duration: Six-month Assignment
Requirements:
- Standard Background & Drug Screen
- +Professional license verification
- + MVR (driving record)
Responsibilities:
Qualifications:
Education & Requirements
- Two (2) years or more case management, utilization management in managed care setting or related experience in a health care delivery setting
- Experience in an HMO or experience in managed care setting preferred
- High school diploma or GED required
- Associate s degree from an accredited institution preferred
- Minimum possession of an active, unrestricted, and unencumbered Vocational Nurse (LVN) license issued by the California Board of Vocational Nursing and Psychiatric Technicians required
- Must have a valid California Driver's License
- Working knowledge and understanding of:
- Member and Provider legal rights to access the grievance and appeals resolution process, within the respective Provider Organization, DHCS, DMHC, and Client and IEHP
- Outside agencies and resources such as CCS, Client, DMHC, or DHCS
- Regulatory guidelines surrounding grievances and appeals per Client, DHCS, and DMHC and NCQA
- Microcomputer applications: spreadsheet, database, and word processing. Excellent written and verbal communication skills
- Proven ability to:
- Demonstrate critical thinking and strong problem-solving capability
- Demonstrate a commitment to incorporate LEAN principles into daily work
- Possess strong attention to detail
- Prioritize work to ensure adherence to project deadlines
- Effectively escalate issues as identified, following established protocols
- Maintain a positive attitude and ability to work in a team setting
Numbers & Facts
| Location | Rancho Cucamonga, CA |
| Industry | Staffing/Employment Agencies |
| Company Size | 2,000 to 2,499 employees |
| Year Founded | 2000 |
| Website | http://www.lancesoft.com/ |
About Company
We are a $125 Million, NMSDC-certified Minority & Woman owned Workforce Solutions Company headquartered in the DC metro area with presence across US with global presence - Canada, Mexico, India, UK, Malaysia, Indonasia, Hongkong, Singapore, UAE. We are specialized in providing Workforce Solutions, SOW project delivery, Engineering Solutions, Creative Services. We currently support 100+ Fortune companies globally and across multiple industry segments. We are currently supporting several massive programs across industry segment nationally/globally (Intel, Ally, AMD, QUALCOMM, Morgan Stanley, Kraft/ Mondelez, MNP, Amdocs, Dell, SanDisk, Medtronic, Becton Dickinson, GE, Lockheed Martin, UTC, L-3 Communications, Caterpillar, BMW, Mercedes Benz, National Grid, Dominion, Energy Future Holdings, PSEG, 3M, Fidelity, Aetna, Humana, Johnson & Johnson, Pfizer, Merck etc).Â
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender, identity, national origin, disability, or protected veteran status.
Skills
- Case Managementunmatched
- Certified Coding Specialist (CCS)unmatched
- Communication Skillsunmatched
- Detail Orientedunmatched
- Driver's Licenseunmatched
- Establish Prioritiesunmatched
- Health Maintenance Organization (HMO)unmatched
- Healthcareunmatched
- High School Diplomaunmatched
- Identify Issuesunmatched
- Legalunmatched
- Licensed Practical Nurse/Licensed Vocational Nurseunmatched
- Maintain Complianceunmatched
- Managed Careunmatched
- National Committee for Quality Assurance (NCQA)unmatched
- Presentation/Verbal Skillsunmatched
- Problem Solving Skillsunmatched
- Professional Licenseunmatched
- Psychiatric Nursingunmatched
- Regulationsunmatched
- Spreadsheetsunmatched
- Team Playerunmatched
- Time Managementunmatched
- Utilization Managementunmatched
- Word Processingunmatched
- Writing Skillsunmatched
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