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Grievance &amp; Appeals Nurse Specialist CalOptima Join Us in this Amazing Opportunity The Team You'll Join We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all. More About the Opportunity We are hoping you will join us as a Grievance &amp; Appeals Nurse Specialist and help shape the future of healthcare where you'll be an integral part of our Grievance &amp; Appeals team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be Full Telework. 
<ul>
<li> If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum. </li>
</ul>
 You will participate in managing CalOptima Health's medical appeals and state hearing reviews for all lines of business, including handling expedited and standard requests. You will ensure appeals and state hearing requests are processed in accordance with regulations, compliance standards and policies and procedures. You will investigate and prepare case narratives and statements of position based on clinical information, benefits and applicable regulations related to member or provider disputes of decisions. You will clearly articulate the facts and CalOptima Health's position regarding disputes to the Administrative Law Judge hearing the case. You will be responsible for creating and reviewing resolution letters for appropriateness of clinical criteria and regulatory requirements. Together, we are building a stronger, more equitable health system. Your Contributions To the Team: 
<ul>
<li>80% - Program Support
<ul>
<li>Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Prepares clinical reviews based on clinical guidelines and provides monitoring of cases involving medical decisions and quality of care or service decisions.</li>
<li>Ensures all cases are completed in accordance with state and federal regulatory requirements including timelines.</li>
<li>Presents recommendations based on clinical review, criteria and organizational policies to CalOptima Health's physician reviewers for final determination.</li>
<li>Resolves complex and sensitive member issues within established timelines.</li>
<li>Maintains departmental database and the integrity of records by accurately entering case actions to assigned cases.</li>
<li>Analyzes and reports cases through GARS' subcommittee.</li>
<li>Oversees state hearing cases.</li>
<li>Assists with the notification process to members or providers on the clinical decision issued.</li>
<li>Discusses appeal process, medical decisions and hearing rights with members.</li>
<li>Assists members in coordinating their services with providers and communicates the status and outcome to members.</li>
<li>Assigns position statements and represents CalOptima Health at state hearings. </li>
</ul>
</li>
<li>15% - Administrative Support
<ul>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.</li>
<li>Participates in departmental meetings, trainings and audits as requested. </li>
</ul>
</li>
<li>5% - Completes other projects and duties as assigned. </li>
</ul>
 Do You Have What the Role Requires? 
<ul>
<li>High school diploma required PLUS 5 years of health care/managed care experience required, preferably in the following related areas of responsibility: grievances and appeals, utilization management and/or quality management; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.</li>
</ul>
 You'll Stand Out More If You Possess the Following: 
<ul>
<li>Current unrestricted Registered Nurse (RN) license to practice in the state of California. </li>
<li>Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Russian, Spanish, Vietnamese).</li>
</ul>
 What the Regulatory Agencies Need You to Possess? 
<ul>
<li>Current unrestricted Licensed Vocational Nurse (LVN) license to practice in the state of California.</li>
</ul>
 Your Knowledge &amp; Abilities to Bring to this Role: 
<ul>
<li>Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. </li>
<li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.</li>
</ul>
 Your Physical Requirements (With or Without Accommodations): 
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul>
 Ways We Are Here For You 
<ul>
<li>You'll enjoy competitive compensation for this role.
<ul>
<li>Our current hiring range is: Pay Grade: 313 - $90,820 - $145,312 ($43.66 - $69.8615). 
<ul>
<li>The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors. </li>
</ul>
</li>
</ul>
</li>
<li>This position is approved for Full Telework (**If the position is Telework, it is eligible in California only**) </li>
<li>A <a href="https://apptrkr.com/get_redirect.php?id=6827312&amp;targetURL=https://www.caloptima.org/en/careers#benefits" target="_blank">comprehensive benefits package</a> </li>
<li>CalPERS pension program and additional retirement packages. </li>
<li>Additional benefits and perks including:
<ul>
<li>A generous PTO program</li>
<li>A quality work life balance</li>
<li>Various wellness programs</li>
<li>Tuition Reimbursement</li>
<li>Professional development opportunities</li>
<li>Career development opportunities</li>
<li>Flexible scheduling</li>
<li>And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.</li>
</ul>
</li>
</ul>
 Our Work Environment: If located at the 500, 505 Building or a remote work location: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul>
 If located at PACE: 
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 If located in the Community: 
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. </li>
<li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul>
 Why Join Us? We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare. What's Your Next Step? All Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is January 13, 2026 at 9:00 PM (PST). We are encouraging you to apply early. If you apply after the first review date, your application is not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. Our Commitment to You Your application and resume will be reviewed by a dedicated recruiter to this position. If your experience matches what we need, we will reach out to you to discuss the next steps. The selection process may include, but is not limited to, a skills assessment, phone screen and interview. If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet. We will make sure to keep you updated through each step of the process on your candidate portal. Please make sure to watch for updates on your candidate portal and you emails which will be sent to the email address you listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process. CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together. CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. To apply, please visit: <a href="https://apptrkr.com/6827312" target="_blank">https://jobs.caloptima.org/jobs/grievance-appeals-nurse-specialist-505-city-parkway-west-california-united-states-15e815c2-3fcd-4db0-a51e-8078f72ffc27</a> Copyright 2025 Jobelephant.com Inc. All rights reserved. <a href="https://www.jobelephant.com/" target="_blank">Posted by the FREE value-added recruitment advertising agency</a> jeid-6b482c6ee7f7164a8ac6b7e408651c04

Grievance & Appeals Nurse Specialist

<h3>Job Description</h3>
Job Description
Licensed Practical Nurse (LPN) 
Facility: Arbors at Springfield
We invite you to apply and be part of a team that truly values your contribution. We offer competitive wages and are committed to fostering a workplace where growth, teamwork, and patient-centered care are at the forefront. At the end of each day, knowing that you’ve made a meaningful impact in the lives of our residents will be your greatest reward.
Why Choose Arbors?
<ul>
<li>One of Ohio’s Largest Providers of long-term care skilled nursing and short-term rehabilitation services.</li>
<li>Employee Focus: We foster a positive culture where employees feel valued, trusted, and have opportunities for growth.</li>
<li>Employee Recognition: Regular acknowledgement and celebration of individual and team achievements.</li>
<li>Career Development: Opportunities for learning, training, and advancement to help you grow professionally.</li>
</ul>
Key Benefit Package Options?
<ul>
<li>Medical Benefits: Affordable medical insurance options through Anthem Blue Cross Blue Shield.</li>
<li>Additional Healthcare Benefits: Dental, vision, and prescription drug insurance options via leading insurance providers.</li>
<li>Flexible Pay Options: Get paid daily, weekly, or bi-weekly through UKG Wallet.</li>
<li>Benefits Concierge: Internal company assistance in understanding and utilizing your benefit options.</li>
<li>Pet Insurance: Three options available</li>
<li>Education Assistance: Tuition reimbursement and student loan repayment options.</li>
<li>Retirement Savings with 401K.</li>
<li>HSA and FSA options</li>
<li>Unlimited Referral Bonuses.</li>
</ul>
Start a rewarding and stable career with Arbors today!
Summary: The Licensed Practical Nurse (LPN) coordinates and provides nursing care for residents and provides supervision and guidance to clinical staff members. Qualifications:Education:
<ul>
<li>Graduate of accredited LPN/LNV school of nursing.</li>
</ul>
Licenses/Certification: 
<ul>
<li>Valid LPN/LVN license in the state employed.</li>
<li>Valid CPR certification.</li>
</ul>
Experience:
<ul>
<li>One year experience in nursing preferred. </li>
</ul>
Job Functions: 
<ul>
<li>Documents the resident’s condition and nursing needs.</li>
<li>Accurately and promptly implements physicians’ orders.</li>
<li>Assigns nursing care to team members in accordance with the resident’s needs and the person’s capabilities and qualifications.</li>
<li>Supervises, directs, and evaluates junior staff members and CNAs.</li>
<li>Administers medications and performs treatments for assigned residents, and documents that treatment as required by Company, and local, state and federal rules and regulations.</li>
<li>Participates in orientation and in-service training for personnel.</li>
<li>Ensures that supplies are utilized economically and equipment is clean and maintained in a safe manner.</li>
<li>Reports and records pertinent observations and reactions regarding residents.</li>
<li>Coordinates nursing care of residents when scheduled for therapy or procedures by other departments.</li>
<li>Interviews applicants and recommends hires. Participates in counseling, disciplinary action and termination of staff, to extent permitted by state practice act.</li>
<li>Supervises nursing unit, which includes scheduling and directing the nursing staff to extent permitted by state practice act.</li>
<li>Assures that inventory and supplies are maintained on the unit and communicates need for housekeeping, maintenance, or dietary assistance.</li>
<li>Performs other tasks as assigned.</li>
</ul>
Knowledge/Skills/Abilities:
<ul>
<li>Skilled in directing and motivating the workforce.</li>
<li>Ability to work cooperatively as a member of a team.</li>
<li>Ability to communicate effectively with residents and their family members, and at all levels of the organization.</li>
<li>Ability to react decisively and quickly in emergency situations.</li>
<li>Knowledge of training techniques for clinical staff.</li>
<li>Ability to maintain confidentiality.</li>
</ul>

Licensed Practical Nurse (LPN)

<h3>Job Description</h3>
Job Description
Help at Home is hiring Nurses (LPN) in your community TODAY.
 
Pay: $18-$22/hour
Various shifts available in many locations!
Help at Home, LLC, is the nation’s leading provider of high-quality home care and support solutions. Our goal is to enable the highest level of personal independence and meaningful lives for our clients. Help at Home is committed to delivering a gold standard in care through our attentive and well-trained staff who support our clients comfortably and safely aging in place.
 
Our&nbsp;LPNs&nbsp;focus on ensuring quality of care.
&nbsp;
Benefits:
Help at Home strives to be an employer of choice and our employees are the foundation of our work. We offer a wide variety of competitive benefits, to include in-depth training opportunities in order to ensure success.
&nbsp;
Duties:
As a LPN, you will work 1:1 with one client for the duration of your shift and support them with the following:
<ul>
<li>Adhere to the outlined care plan</li>
<li>Document tasks, observations and evaluate outcomes</li>
<li>Ensure quality care is delivered by creating, implementing, monitoring and enforcing quality assurance policies and procedures</li>
<li>Receive clinical direction and oversight from the staff RN</li>
<li>Assist with other duties as needed</li>
</ul>
&nbsp;
Minimum Qualifications:
<ul>
<li>Current Mississippi (or Compact State) LPN license</li>
<li>One (1) or more years nursing experience, preferably in personal care home industry</li>
<li>Reliable transportation and valid driver’s license</li>
</ul>
&nbsp;
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions upon request.
&nbsp;
Help&nbsp;At Home, LLC. is an Equal Employment Opportunity (EEO) employer and welcomes all qualified applicants. Applicants will receive fair and impartial consideration without regard to race, sex, color, religion, national origin, age, disability, veteran status, genetic data, or religion or other legally protected status.
&nbsp;
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions upon request.
Data Security and Privacy Statement
At Help at Home, we prioritize protecting your personal information during the hiring process. We comply with all relevant data privacy regulations, including HIPAA and SOX where applicable. Your data will only be used to assess your employment suitability and won't be shared with unauthorized parties.
We use strong security measures to protect your information from unauthorized access or disclosure. By submitting your application, you consent to this process. You can access, modify, or request deletion of your data by contacting us.
Employees must adhere to our data protection policies and legal requirements to safeguard sensitive information.

LPN (Licensed Practical Nurse)

<h3>Job Description</h3>
Job Description???? Now Hiring: Licensed Practical Nurse (LPN)
Substance Abuse/Mental Health PHP
???? Location: Renaissance Recovery Tennessee ???? Schedule: Monday-Friday | Daytime Hours ????️‍⚕️ Reports To: Clinical Director / Medical Director
Position Overview
We are seeking a compassionate and detail-oriented Licensed Practical Nurse (LPN) to join our Mental Health Partial Hospitalization Program (PHP). This role provides vital nursing and clinical support within a structured outpatient setting, working closely with providers and a multidisciplinary treatment team.
The LPN plays a key role in supporting provider visits, medication management, patient monitoring, and therapeutic programming, while serving as a liaison between providers, patients, technicians, and leadership staff. This is an excellent opportunity for an LPN passionate about mental health care and collaborative, patient-centered treatment.
Key ResponsibilitiesClinical Support &amp; Patient Care
<ul>
<li>
Assist psychiatric providers during patient visits, including preparation, documentation support, and follow-up coordination
</li>
<li>
Obtain and document vital signs and required clinical measurements
</li>
<li>
Conduct patient check-ins and clinical assessments as indicated
</li>
<li>
Monitor patients for medication side effects, adverse reactions, and changes in mental or physical status
</li>
<li>
Assist behavioral health technicians with urine drug screens, including collection, documentation, and chain-of-custody procedures
</li>
</ul>
Medication Management
<ul>
<li>
Coordinate medication refills with providers and pharmacies
</li>
<li>
Support medication reconciliation and provider-patient communication
</li>
<li>
Provide patient education on medications, including purpose, dosing, side effects, and adherence
</li>
<li>
Assist with medication organization and oversight at housing locations when applicable
</li>
</ul>
Laboratory &amp; Diagnostic Coordination
<ul>
<li>
Order labs and diagnostic testing per provider orders
</li>
<li>
Track, review, and communicate lab results to providers and the treatment team
</li>
<li>
Ensure timely follow-up on abnormal findings
</li>
</ul>
Group Facilitation &amp; Patient Education
<ul>
<li>Facilitate 1-2 psychoeducational groups per week</li>
<li>
Provide individualized health education as needed
</li>
</ul>
Team Collaboration &amp; Program Support
<ul>
<li>
Collaborate with psychiatrists, therapists, case managers, and behavioral health technicians
</li>
<li>
Assist with care coordination, documentation, and clinical communication
</li>
<li>
Support program operations and ensure compliance with clinical policies, safety standards, and regulatory requirements
</li>
</ul>
Qualifications
<ul>
<li>
Active Licensed Practical Nurse (LPN) license in good standing
</li>
<li>
Minimum 2 years of experience in mental health, behavioral health, or substance use treatment.
</li>
<li>
Experience in PHP, IOP, residential, or psychiatric settings (preferred)
</li>
<li>
Knowledge of psychiatric medications and common medical conditions
</li>
<li>
Strong organizational, communication, and documentation skills
</li>
<li>
Comfortable working in a fast-paced, multidisciplinary environment
</li>
</ul>
Skills &amp; Competencies
<ul>
<li>
Strong clinical assessment and documentation skills
</li>
<li>
Therapeutic communication and patient engagement
</li>
<li>
Knowledge of infection control and communicable disease protocols
</li>
<li>
Ability to manage multiple priorities with attention to detail
</li>
<li>
Team-oriented, dependable, and patient-centered
</li>
</ul>
Why Join Us?
<ul>
<li>
Consistent weekday, daytime schedule
</li>
<li>
Collaborative and supportive clinical environment
</li>
<li>
Meaningful work supporting individuals on their mental health recovery journey
</li>
</ul>
???? Apply today to join a team committed to compassionate, high-quality mental health care. 
Send your resume/cover letter to <a href="mailto:HR@RR-TN.com" target="_blank">HR@RR-TN.com</a> to stand out from the crowd!

<h3>Job Description</h3>
Job Description
Overview
Are you a caring LPN looking to make strong connections and an impact on patients? If you want to work in an environment where you can become your best possible self JOIN US! You can find opportunities to grow your career through meaningful work, leading with a servant heart, professional development, and a great team to support you! 

 
Responsibilities
<ul>
<li>Deliver exceptional nursing services to our patients and residents maintaining the highest degree of quality and compassionate care. </li>
<li>Supervision of day-to-day activities performed by assigned nursing assistants </li>
<li>Operate in accordance with Federal, State, and Local Standards, guidelines and regulations and as required by Director of Nursing. </li>
<li>Confirm that all nursing personnel assigned to you comply with the written policies and procedures established by the facility. </li>
</ul>
 
Qualifications
<ul>
<li>Possess an Active LPN license in the state of residence </li>
<li>Current/active CPR Certification </li>
<li>Strong attention to detail and accuracy, excellent organizational skills with the ability to prioritize, coordinate and simultaneously maintain multiple projects with a high level of quality and productivity. </li>
<li>Excellent technical, assessment, and documentation skills with the ability to maintain confidentiality. </li>
</ul>

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