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Appeals and Grievances LVN
Company : Catholic Health Initiatives
Location : Rancho Cordova, CA, 95670-7956
Job Type : Full Time
Salary : 32.38-48.17 HOUR
Date Posted : 3 January 2026
Job Summary and Responsibilities
The Appeals and Grievances LVN is a critical role responsible for managing and resolving all medical necessity appeal requests from various stakeholders, including third-party payers, patients, and government entities. This individual acts as a primary liaison for clinical denials, navigating appeal processes through all delegated levels.
Key responsibilities include intake, prioritization, and thorough review of appealed cases, ensuring all relevant documentation is presented to the Medical Director. The nurse must meticulously track and document all appeal activities, guaranteeing timely resolution in compliance with federal, state, and local regulations, including CMS guidelines.
This role involves identifying necessary documentation for investigations, preparing files for regulatory appeals, and maintaining a detailed activity log for leadership review. The nurse will actively participate in audits, identifying and implementing process improvements to enhance efficiency and mitigate revenue loss due to denials. Staying current with plan policies and maintaining patient confidentiality (HIPAA) are also essential.
Ultimately, the Appeals and Grievances Nurse monitors denial trends, recommends corrective actions, and provides regular reports to management and regulatory bodies, contributing to improved clinical quality and financial outcomes.
***Please note: This position is hybrid in-office/clinic and work from home.
Job Requirements
Minimum Qualifications:
- 2+ years administrative experience in a compliance auditing arena. Previous experience in a similar administrative or coordination role.
- Associates degree, or 3 years of industry or job related experience, in lieu of a degree.
- Clear and current CA Licensed Vocational Nurse (LVN) license.
Preferred Qualifications:
- Bachelors degree, or 5 years of industry or job related expereince, in lieu of degree, preferred.
- Certified Compliance Professional (CCP), Certified Professional in Healthcare Quality (CPQH), Certified Healthcare Auditor (CHA) preferred.
- 2 years managed care experience preferred.
- 1 year delegation oversight experience preferred.
- Regulatory audit experience preferred.
Dignity Health Medical Foundation, established in 1993, is a California nonprofit public benefit corporation with care centers throughout California. Dignity Health Medical Foundation is an affiliate of Dignity Health – one of the largest health systems in the nation - with hospitals and care centers in California, Arizona and Nevada. Today, Dignity Health Medical Foundation works hand-in-hand with physicians and providers throughout California to provide comprehensive health care services to the many communities we serve. As Dignity Health Medical Foundation continues to grow and establish new premier care centers, we provide increasing support and investment in the latest technologies, finest physicians and state-of-the-art medical facilities. Our 130+ clinics across the state of California deliver high-quality, patient-centric care with an emphasis on humankindness. Through affiliations with Dignity Health hospitals, along with our joint ventures and partnerships, we offer a robust, state-of-the-art health care delivery system in the communities we serve .We strive to create purposeful work settings where staff can provide great care, while advancing in knowledge and experience through challenging work assignments and stimulating relationships. Our staff is well-trained and highly skilled, qualities that are vital to maintaining excellence in care and service.
One Community. One Mission. One California
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Frequently asked questions
In Rancho Cordova, Appeals and Grievances LVNs focus on resolving medical necessity appeals, requiring strong skills in case documentation and regulatory compliance, unlike typical bedside LVN roles. This position demands expertise in handling denials and coordinating with medical directors to improve patient care outcomes.
Certifications like Certified Compliance Professional (CCP), Certified Professional in Healthcare Quality (CPHQ), and Certified Healthcare Auditor (CHA) elevate proficiency in appeals management. These credentials deepen understanding of healthcare regulations, audit processes, and quality improvement crucial for success in this LVN niche.
This role can lead to advanced positions in healthcare compliance, managed care coordination, or nursing case management. With experience, LVNs often transition to roles involving delegation oversight, audit leadership, or quality assurance, especially within integrated health systems like Catholic Health Initiatives.
Yes, LVNs at Catholic Health Initiatives navigate complex appeal processes within a large, multi-state health system. They must balance regulatory compliance with patient advocacy, while adapting to hybrid work models involving both clinic and remote tasks, demanding excellent organizational and communication skills.
Catholic Health Initiatives offers ongoing training in regulatory updates, audit techniques, and managed care strategies. LVNs benefit from access to advanced technologies, mentorship programs, and opportunities to engage in process improvement projects, fostering growth within a mission-driven healthcare environment.
Appeals and Grievances LVNs in Rancho Cordova typically earn between $60,000 and $75,000 annually. This range reflects local market demand, specialized skill requirements, and compliance expertise, making it competitive within the California healthcare sector.
Rancho Cordova shows a steady demand for Appeals and Grievances LVNs due to its growing healthcare networks. While larger metro areas may offer more roles, the region provides a balanced mix of opportunity and manageable competition, especially within nonprofit organizations like Catholic Health Initiatives.
Commuting in Rancho Cordova is generally manageable, with access to major highways and public transit options. The hybrid work model offered by Catholic Health Initiatives further reduces daily travel needs, allowing LVNs to split time between clinic and remote work effectively.
Emphasize expertise in clinical denial management, thorough documentation, regulatory knowledge (including CMS guidelines), and effective communication with stakeholders. Administrative auditing experience and proficiency in managed care processes are also highly valued.
Daily duties include reviewing appeal cases, coordinating documentation for medical directors, tracking appeal statuses, and preparing files for regulatory audits. The role also involves analyzing denial trends and recommending process improvements to optimize clinical and financial outcomes.