Schedule: The position is 100% Remote, and the candidates must reside in Southern California



Description:

The Temporary Grievance & Appeals Nurse is responsible for managing and coordinating grievance and appeal cases in compliance policies and state and federal regulatory requirements, including CMS, DHCS, DMHC, and NCQA standards. This role partners closely with IPAs, hospitals, providers, and internal departments to ensure timely resolution of cases, appropriate care coordination, and delivery of high-quality member outcomes. The nurse also serves as a clinical subject matter expert, providing guidance on grievance processes, regulatory compliance, and quality improvement initiatives.

What You Will Do:

• Manage and process grievance and appeal cases in compliance with regulatory and internal guidelines


• Coordinate care with PCP...