Los Angeles, California, United States · Hybrid
$102k–$163k/yr
Salary Range: $102,183.00 (Min.) - $132,838.00 (Mid.) - $163,492.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-i…
Skills: Healthcare Regulations, Managed Care Guidelines, Critical Thinking, Problem Solving, Communication
Los Angeles, California, United States · On-site
$27/hr–$32/hr
As a General Manager, you’ll be the spark that keeps the flame alive, leading a passionate team, driving success, and ensuring every guest gets a taste of the Loco experience. You’ll oversee all restaurant op…
Skills: Restaurant Operations, Team Leadership, Staff Scheduling, Labor Management, Performance Coaching
Los Angeles, California, United States · Hybrid
$81k–$120k/yr
Clean luxury. Better for you. At Everlane, we believe luxury should be as effortless as it is conscious. We partner with ethical factories, work with premium, sustainably sourced materials, and strive to leave the indust…
Skills: Merchandising, Category Strategy, Assortment Planning, Data Analysis, Pricing Strategy
Los Angeles, California, United States · On-site
$140k–$170k/yr
Description Integrated Water Services (IWS) is redefining how water is treated, reused, and managed. For more than 20 years, we have pioneered modular water and wastewater treatment solutions that help municipalities, de…
Skills: Business Development, Consultative Sales, Negotiation, Relationship Building, Pipeline Management
Los Angeles, California, United States · On-site
$20/hr–$26/hr
Honey Birdette was created by women for women, to offer an experience unlike any other lingerie retailer. We are a luxury lifestyle brand offering high-end lingerie and premium bedroom accessories. Bold, innovative, and …
Skills: Retail Sales Supervision, Clienteling, Cash Handling, POS Systems, Team Leadership
Los Angeles, California, United States · On-site
This position represents 4 openings #SRN Job Summary: As the leader of the health care team, provides professional nursing care, utilizing the nursing process in accordance with established standards of care, policies, a…
Skills: Nursing Process, Patient Assessment, Care Planning, Emergency Nursing, Patient Safety
Los Angeles, California, United States · On-site
This position represent 3 openings #SRN Job Summary: As the leader of the health care team, provides professional nursing care, utilizing the nursing process in accordance with established standards of care, policies, an…
Skills: Nursing Process, Patient Assessment, Emergency Care, Patient Education, Care Planning
Los Angeles, California, United States · On-site
This position represents 4 openings #SRN Job Summary: As the leader of the health care team, provides professional nursing care, utilizing the nursing process in accordance with established standards of care, policies, a…
Skills: Nursing Process, Patient Assessment, Emergency Care, Leadership, Patient Education
Los Angeles, California, United States · On-site
This position represents 4 openings #SRN Job Summary: As the leader of the health care team, provides professional nursing care, utilizing the nursing process in accordance with established standards of care, policies, a…
Skills: Nursing Process, Patient Assessment, Emergency Care, Leadership, Patient Education
Los Angeles, California, United States · On-site
This position represents 6 openings. #SRN Job Summary: As the leader of the health care team, provides professional nursing care, utilizing the nursing process in accordance with established standards of care, policies, …
Skills: Nursing Process, Patient Assessment, Emergency Care, Leadership, Patient Education
Los Angeles, California, United States · On-site
This position represents 4 openings #SRN Job Summary: As the leader of the health care team, provides professional nursing care, utilizing the nursing process in accordance with established standards of care, policies, a…
Skills: Nursing Process, Patient Assessment, Emergency Care, Patient Education, Care Planning
Los Angeles, California, United States · On-site
Job Summary: As the leader of the health care team, provides professional nursing care, utilizing the nursing process in accordance with established standards of care, policies, and procedures. Demonstrates performance c…
Skills: Nursing Process, Patient Assessment, Emergency Care, Leadership, Patient Education
Los Angeles, California, United States · On-site
Job Summary: As the leader of the health care team, provides professional nursing care, utilizing the nursing process in accordance with established standards of care, policies, and procedures. Demonstrates performance c…
Skills: Nursing Process, Patient Assessment, Emergency Care, Leadership, Patient Education
Los Angeles, California, United States · On-site
Job Summary: As the leader of the health care team, provides professional nursing care, utilizing the nursing process in accordance with established standards of care, policies, and procedures. Demonstrates performance c…
Skills: Nursing Process, Patient Assessment, Emergency Care, Leadership, Patient Education
Los Angeles, California, United States · On-site
This position represents 2 openings #SRN Job Summary: As the leader of the health care team, provides professional nursing care, utilizing the nursing process in accordance with established standards of care, policies, a…
Skills: Nursing Process, Patient Assessment, Emergency Care, Leadership, Patient Education
Los Angeles, California, United States · On-site
This position represents 6 openings #SRN Job Summary: As the leader of the health care team, provides professional nursing care, utilizing the nursing process in accordance with established standards of care, policies, a…
Skills: Nursing Process, Patient Assessment, Emergency Care, Leadership, Patient Education
Los Angeles, California, United States · On-site
$175k–$200k/yr
Job Title: Senior Construction Manager Location: Los Angeles, CA 90037 Anticipated Start Date: August 2026 Pay Range: $175K - $200K per year plus benefits Project Duration: Ongoing; approx. 2 years with potential extensi…
Skills: Construction Management, Progressive Design-Build, Public Works, Technical Writing, Microsoft Project
Los Angeles, California, United States · Hybrid
$190k–$210k/yr
Description The Senior Director of Integrated Marketing owns the three channels where BELLAMI shows up most powerfully in culture: social, influencer and ambassador, and public relations. This is a builder's seat, full o…
Skills: Integrated Marketing, Influencer Strategy, Ambassador Program Management, Public Relations, Social Media Strategy
Los Angeles, California, United States · On-site
$20/hr–$22/hr
The pay for this position starts at $20.50-$22.00/hour +Tips +Bonus Be a Leader. Be a Difference Maker. At our restaurant, Shift Leaders aren’t just supervisors—they’re hands-on leaders who set the tone…
Skills: Leadership, Team Management, Customer Service, Cash Handling, POS Systems
Los Angeles, California, United States · Hybrid
$105k–$115k/yr
POSITION OVERVIEW IW Group is seeking a strategic and client-focused Senior Media Planner, Investment & Strategy to lead media planning and investment recommendations across a portfolio of high-profile clients, including…
Skills: Media Planning, Media Investment, Digital Strategy, Budget Management, Vendor Negotiation
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The Lead Appeals and Grievances RN is responsible for developing a cohesive Appeals and Grievance clinical unit and ensuring the effective investigation and resolution of clinical grievances and appeals. This role includes reviewing complex cases, conducting audits, and mentoring staff.
Candidates must have at least 8 years of clinical appeals and grievances experience, including 2 years in Medicare/Medicaid, and 1 year of leadership experience. An Associate's Degree in Nursing is required, with a Bachelor's Degree preferred.
Salary Range: $102,183.00 (Min.) - $132,838.00 (Mid.) - $163,492.00 (Max.)
Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.
Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.
The Lead Appeals and Grievances RN is responsible for assisting with the development of a successful and cohesive Appeals and Grievance (A&G) clinical unit.
This position is responsible for the quality review of complex and/or escalated clinical A&G cases for all lines of business (LOB). The Lead will assist in identifying areas of improvement in increasing positive audit outcomes and improved Customer Service to L.A. Care’s (LAC) membership. This position will ensure the effective investigation and resolution of clinical grievances, appeals, complaints, and complex issues in alignment with L.A. Care policy and procedures along with all relevant regulatory guidelines.
Leads and works closely with assigned team daily. This position will mentor, coach, and may provide feedback to management on performance of staff. Ensure team effectiveness and project completion.
Review and process complex and/or escalated clinical A&G cases. Analyze the patient medical records, clinical documentation, and insurance policies to determine medical necessity. Prepares and reviews A&G files for submission to providers and internal departments.
Work with other departments to ensure all aspects of a case are appropriately managed.
Conduct targeted and random clinical case audits to ensure that all regulatory and departmental guidelines, policies, procedures, and standards are met. Work closely with the leadership team to create and/or modify Desk Level Procedures and recommend enhancements to process and procedures.
Assist the Clinical Supervisors in identifying deviations in performance and process changes are implemented to redirect performance to acceptable levels. Recommend and implement resolutions, new processes, and/or process improvement.
Provide accurate and timely written statistical reports that include historical and/or current data to aid in projecting or evaluating compliance status. Identify and analyze trends in appeals and grievances to find the root cause of denials.
Check, verify and ensure that all clinical A&G cases are processed accurately and within established timelines to meet or exceed member satisfaction goals and regulatory (CMS, DMHC, DHCS, NCQA), Health and Safety Code and company compliance.
Maintain documentation of all communications in the A&G system to ensure thorough tracking of case status.
Lead the work of assigned staff; regularly assigns and checks the work of others, providing guidance, training, and feedback on performance to department management. Work closely with management to review performance and quality standards on an ongoing basis. As well as motivational programs needed to achieve regulatory standards.
Act as a back-up to the Supervisor in leading meetings and handling escalations as required.
Perform other duties as assigned.
Required:
At least 8 years of clinical appeals and grievances experience in a managed care, utilization management and/or case management setting,
At least 2 years in Medicare/ Medicaid in a managed care/ health plan environment.
At least 1 year of leading a process, program, or staff experience.
Preferred:
Clinical acute experience.
Required:
Extensive knowledge of healthcare regulations and managed care guidelines
Demonstrated ability to provide recommendations towards resolution.
Strong critical thinking and problem-solving abilities to assess complex clinical cases and evaluate medical necessity.
Ability to communication, conflict resolution, and motivational skills.
Ability to work independently and closely with a team in a collaborative and interactive environment.
Ability to adjust to changing circumstances within the team.
Good verbal and written communication skills.
Preferred:
Strong project management skills with the ability to manage multiple training initiatives simultaneously.
This position requires work after hours, on weekends, holidays, a hybrid remote schedule, and occasional flexibility in hours/shift in critical situations and work on-call.
This position requires handling various caseloads and flexibility to adapt to changing priorities, which may include but not limited to redistributed work assignments, team projects, and other priorities as assigned.
Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.
Elevating health care for all of L.A. County
L.A. Care’s mission is to provide access to quality health care for L.A. County’s low-income communities, and to support the safety net required to achieve that purpose. As a publicly operated health plan, L.A. Care Health Plan serves more than 2.6 million members in Los Angeles County, making it the largest publicly operated health plan in the country. L.A. Care offers four health coverage plans including Medi-Cal, L.A. Care Covered™, L.A. Care Medicare Plus and the PASC-SEIU Homecare Workers Health Care Plan, all dedicated to being accountable and responsive to members. L.A. Care prioritizes quality, access and inclusion, elevating health care for all of L.A. County. For more information, follow us on X, Facebook, LinkedIn, Instagram and YouTube. To learn more, visit www.lacare.org. *For urgent inquiries: 1-888-4LA-CARE (1-888-452-2273)
Offices: 1200 W 7th St, Los Angeles, California 90017, US
There are currently 6,645 open management & leadership positions in Los Angeles, CA listed on Clera. New openings are added daily as companies post roles.
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