Licensed Vocational Nurse Supervisor, Quality Performance & Grievance and Appeals
Job Overview
The Supervisor, Quality, Grievance & Appeals is responsible for overseeing Grievance & Appeals (G&A) functions and leading Quality Management activities.
This position collaborates with Quality leadership, Utilization Management, Population Health, and operational teams to identify trends, implement corrective actions, and promote a positive member and provider experience.
This role provides supervision to both clinical and non-clinical staff and ensures timely, accurate, and compliant processing of grievances and appeals, potential quality issues (PQIs), and quality-of-care reviews.
Minimum Requirements
- Bachelor’s degree in healthcare administration, public health, nursing, or a related field (or equivalent experience).
- Minimum of 3 years of experience in healthcare grievances and appeals, quality, compliance, or managed care operations.
- Minimum of 2 years of healthcare quality improvement or performance measurement experience (HEDIS/Stars preferred).
- Experience conducting PQI/QOC reviews or supporting clinical quality investigations.
- Minimum 1 year of supervisory or lead experience.
- A current LVN license issued by the State of California, Vocational Nursing, and Psychiatric Technicians.
- A minimum requirement of a valid BLS certification or higher, following the American Heart Association (AHA) or the American Red Cross guidelines.
Compensation
$73,262.64 - $91,540.80 annually
Compensation Disclaimer: Actual salary offers are considered by various factors, including budget, experience, skills, education, licensure and certifications, and other business considerations.
Benefits & Career Development
- Medical, Dental and Vision insurance
- 403(b) Retirement savings plans with employer matching contributions
- Flexible Spending Accounts
- Commuter Flexible Spending
- Career Advancement & Development opportunities
- Paid Time Off & Holidays
- Paid CME Days
- Malpractice insurance and tail coverage
- Tuition Reimbursement Program
- Corporate Employee Discounts
- Employee Referral Bonus Program
- Pet Care Insurance