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)