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Registered Nurse Grievance and Appeals Supervisor

Los Angeles, CA · On-site

$49 - $63/hr

The RN Grievance and Appeals Supervisor would be working for a Fortune 500 managed care company and has career growth potential. This would be full time / 40+ hours per week. If you are interested in ...

Frederick Health

Grievance Coordinator

Frederick, MD · On-site

$19.75 - $24.75/hr

Job Summary The Grievance Coordinator coordinates, supervises and ensures timely resolution of ... Graduate of an approved Bachelor Degree program in Nursing, or Health Care Administration with 3-5 ...

Frederick Health

Grievance Coordinator

Frederick, MD · On-site

$19.75 - $24.75/hr

Job Summary The Grievance Coordinator coordinates, supervises and ensures timely resolution of ... Graduate of an approved Bachelor Degree program in Nursing, or Health Care Administration with 3-5 ...

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$65

How much do grievance nurse jobs pay per hour?

As of Aug 13, 2026, the average hourly pay for grievance nurse in the United States is $38.62, according to ZipRecruiter salary data. Most workers in this role earn between $29.57 and $43.27 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a grievance nurse, and why are they important?

To thrive as a Grievance Nurse, you need a current RN license, strong clinical knowledge, and a solid understanding of healthcare regulations, particularly in areas such as appeals, grievances, and medical necessity. Familiarity with case management software, healthcare documentation systems, and regulatory platforms like Medicare and Medicaid guidelines is essential. Exceptional written communication, critical thinking, and conflict resolution skills help you effectively analyze cases and advocate for patients. These skills ensure accurate evaluation of complaints, compliance with regulations, and fair resolutions that support both patient rights and organizational standards.

What is a grievance nurse?

A Grievance Nurse is a registered nurse who reviews, investigates, and resolves complaints or grievances from patients or members regarding their healthcare services or insurance coverage. They work for hospitals, health insurance companies, or other healthcare organizations to ensure that patient concerns are addressed fairly and in compliance with regulatory standards. Grievance Nurses analyze medical records, communicate with providers and patients, and help ensure care quality and patient satisfaction. They also play a key role in quality improvement by identifying patterns or systemic issues in healthcare delivery.

What are common challenges grievance nurses face when investigating member complaints, and how are these addressed within the team?

Grievance Nurses often encounter challenges such as unclear documentation, incomplete medical records, or complex cases requiring coordination across multiple departments. To address these, teams typically implement structured review processes and regular case discussions to ensure thorough investigation and appropriate resolution. Collaboration with medical directors, quality assurance staff, and member services is essential to gather relevant information and resolve member concerns efficiently, while also maintaining compliance with regulatory guidelines.

What is the difference between Grievance Nurse vs Case Manager Nurse?

AspectGrievance NurseCase Manager Nurse
CredentialsRN license, often with certifications in patient advocacy or dispute resolutionRN license, case management certification (e.g., CCM)
Work EnvironmentHospitals, insurance companies, healthcare organizations handling patient complaintsHospitals, insurance companies, community health settings managing patient care plans
Employer & IndustryInsurance providers, healthcare facilities, patient advocacy groupsInsurance companies, healthcare organizations, managed care providers
Search & Comparison IntentUnderstanding roles related to patient complaints and advocacyUnderstanding roles focused on care coordination and patient management

While both roles require RN licensure, Grievance Nurses primarily handle patient complaints and advocacy within healthcare or insurance settings. Case Manager Nurses focus on coordinating patient care, managing treatment plans, and ensuring proper healthcare delivery. Both roles are vital in healthcare but serve different functions related to patient support and care management.

More about Grievance Nurse jobs

What are the most commonly searched types of Grievance Nurse jobs?

The most popular types of Grievance Nurse jobs are:

What job categories do people searching Grievance Nurse jobs look for?

The top searched job categories for Grievance Nurse jobs are:

Grievance Nurse jobs near you
Infographic showing various Grievance Nurse job openings in the United States as of August 2026, with employment types broken down into 4% As Needed, 58% Full Time, 16% Part Time, and 22% Contract. Highlights an 99% Physical, and 1% Remote job distribution, with an average salary of $80,321 per year, or $38.6 per hour.

Appeals & Grievances Nurse

Western Health Advantage

Sacramento, CA • On-site

Full-time

Re-posted 18 days ago

Job description

Appeals & Grievances Nurse (RN)Western Health Advantage

Location: Sacramento, CA (Hybrid)
Job Type: Full-Time, Exempt
Salary: $95,000–$115,000 annually
Travel: Occasional travel required
"Purpose that inspires. Impact that improves lives. Join us in building healthier communities." 
Western Health Advantage

Join Our Team

Western Health Advantage (WHA) is seeking an experienced Appeals & Grievances Nurse (RN) to join our Utilization Management team. This role is ideal for a registered nurse with managed care experience who is passionate about ensuring members receive timely, clinically sound, and compliant reviews of appeals and grievances.

Reporting to the Utilization Operations Director, you will collaborate with Medical Directors, Clinical Pharmacists, Appeals & Grievances staff, and contracted provider groups to evaluate complex cases, ensure regulatory compliance, and support exceptional member outcomes.

What You'll Do

As the Appeals & Grievances Nurse, you will:

  • Review medical necessity appeals and grievances requiring clinical evaluation.
  • Research, analyze, and prepare complex appeal cases involving new technology, experimental treatments, transplants, and other specialized services.
  • Determine clinical urgency and provide guidance to the Appeals & Grievances team.
  • Prepare clinical summaries and recommendations for Medical Director review and Appeal Review Meetings.
  • Draft clinical resolution letters for upheld medical necessity determinations.
  • Partner with contracted Medical Groups, hospitals, and providers to coordinate member care and facilitate smooth transitions across the continuum of care.
  • Collaborate with internal departments including Quality Management, Care Management, Member Services, Sales, Marketing, and Wellness on clinical initiatives and special projects.
  • Assist with referrals to Case Management, Disease Management, and Behavioral Health services.
  • Provide care coordination and support for members receiving transgender surgery services.
  • Maintain and update utilization management reference materials, including prior authorization and DME benefit resources.
  • Support regulatory readiness by participating in DMHC, CMS, and NCQA audits, accreditation activities, RFP responses, and Independent Medical Review submissions.
  • Participate in conference calls with regulatory agencies and provide clinical expertise on appeals and grievance cases.
  • Promote compliance with regulatory requirements while ensuring timely, accurate, and member-focused case resolutions.
What You'll BringRequired Qualifications
  • Bachelor's degree in Nursing (BSN).
  • Active and unrestricted California Registered Nurse (RN) license.
  • 3 years’ experience in utilization/case management, discharge planning and/or appeals & grievances in a managed care environment, with increased responsibilities.
  • Strong clinical assessment, critical thinking, and analytical skills.
  • Excellent written and verbal communication skills.
  • Intermediate Microsoft Office skills, including Excel and Word.
  • Certification in Utilization Management (CPHM, CMCN, or equivalent), Quality Management, or Certified Case Manager (CCM).
  • Knowledge of California Department of Managed Health Care (DMHC) regulations.
  • Familiarity with CMS Medicare regulations.
  • Experience supporting NCQA accreditation activities.
  • Experience preparing regulatory responses, audits, or quality improvement initiatives.
Why Join Western Health Advantage?

At WHA, you'll have the opportunity to make a meaningful impact on the quality and accessibility of healthcare for our members. You'll collaborate with experienced clinical leaders in a supportive, mission-driven environment that values clinical excellence, regulatory compliance, and continuous improvement.

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