Remote Grievance & Appeals Nurse (CA RN)
Centene Corp.
- Remote job
Centene Corp. in California seeks a remote nurse reviewer to handle medical necessity grievances, appeals and denials. The role requires CA RN/LPN/LVN licensure and 2+ years of clinical nursing experience, with NCQA and InterQual knowledge preferred. You will review cases, prepare submissions for the Medical Director, and ensure NCQA-compliant communication with members and providers. Flexible schedules and PST alignment support this essential function. #J-18808-Ljbffr Centene Corp.
- Centene Corp. in California is seeking a remote nurse reviewer to facilitate medical necessity grievances, appeals, and denials. The role requires an active CA RN/LPN/LVN license and PST hours for remote work. You will review clinical data, overturn or uphold denials per...Remote job
- Centene Corp. is seeking a remote RN/LPN/LVN with 2+ years of clinical nursing experience to facilitate medical necessity grievances, appeals and denials. The role requires California licensure and PST hours. You will review clinical data, prepare case reviews for the...Remote job
- Centene Management Company LLC is seeking a nurse to facilitate medical necessity grievances, appeals and denials while reviewing clinical data... ...criteria are met. The role requires California RN/LPN licensing and supports remote work with PST hours. Responsibilities...Remote job
$27.02 - $48.55 per hour
...Facilitate medical necessity grievance, appeals and denials including... ...Candidate must hold California RN Licensure. This position is remote and will work PST hours.... ...3+ years of clinical nursing experience or RN with 2+... ...license. Must be licensed in CA. Pay Range: $27.02 - $48....Remote workHourly payFull timePart timeWork at officeFlexible hours$29 - $52 per hour
...together As a Clinical Grievances Nurse, you will be... ...the flexibility to work remotely* as you take on some tough... ...Current, unrestricted RN license in the state of... ...Must live in the state of CA Preferred Qualifications... ...management experience Clinical appeals and grievances...Remote jobHourly payMinimum wageFull timeWork experience placementLive inLocal areaImmediate startMonday to Friday- A healthcare service provider is seeking an Appeals and Grievances Clinical Specialist to manage member complaints and clinical case resolutions. This is a 100% remote role requiring an RN, LPN, or Dental Hygienist license. Responsibilities include developing cases, researching...Remote work
- HealthEdge is seeking a remote (US) Appeals & Grievances Specialist to independently process complex grievances and conduct medical necessity reviews across inpatient, outpatient, and ancillary services. You will prepare documentation for regulatory standards and coordinate...Remote job
- UnitedHealth Group is seeking a Clinical Grievances Nurse to review retrospective cases for... ...members’ immediate needs. The role embraces remote PST hours with an on-site base in Mesa, AZ, requiring CA residency and an active CA RN license. You will assess care against...Remote jobImmediate start
$53 per hour
Phaxis - Healthcare is hiring for a REMOTE RN opportunity focused on Grievance & Appeals and Utilization Review. The role requires candidates to reside in New York State and hold an active NY RN license. The schedule is Monday-Friday, 9 AM-5 PM, with compensation at $5...Remote jobLong term contractContract workMonday to Friday- Phaxis is hiring a Remote UM / Grievance & Appeals RN (NY License) for a contract role with a New York health plan. If you have owned appeals from intake to final decision letter, we want to talk to you. You will review medical necessity for outpatient and community-based...Remote jobContract work
$52 - $56 per hour
Now hiring: Remote UM / Grievance & Appeals RN (NY License) | Contract | $52-56/hr Are you an RN who has owned appeals cases from intake to final decision... ...York health plan, needs a clinical Grievance & Appeals nurse with a utilization management or case management...Remote jobContract workImmediate start- Centene is seeking a California-licensed nurse (RN or LPN/LVN) for a remote role aligned to Pacific Standard Time hours. You will facilitate medical necessity grievances, appeals, and denials, review clinical data, and determine if criteria are met under NCQA guidelines...Remote job
- Phaxis is seeking an experienced registered nurse to investigate and manage clinical grievances, appeals, and external reviews from intake to resolution. The role emphasizes reviewing medical necessity, quality-of-care concerns, and coordination across settings from outpatient...Remote job
$29 - $52 per hour
About This Role As a Clinical Grievances Nurse, you will review incoming retrospective... ...hours and are looking for a remote opportunity. Highlights Pay :... ...: Must live in the state of CA What You'll Do Perform... ...metrics Requirements Education RN license in the state of residency...Remote jobFull timeLive inImmediate startDay shift$60.78k
...Appeals and Grievances Specialist IIJob Category: Customer Service Department: Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position Type: Full Time Salary Range: $60,778.00 (Min.)... ..., on weekends, holidays, a hybrid remote schedule, occasional flexibility in...Remote workFull timeLocal areaShift workWeekend work$53 per hour
REMOTE RN OPPORTUNITY - GRIEVANCE & APPEALS / UTILIZATION REVIEW We're hiring experienced Registered Nurses to join a leading healthcare organization in a fully remote role! Position Details Location: Remote - Must reside in New York State Schedule: Monday-Friday | 9 AM...Remote jobLong term contractMonday to Friday$63.9k - $83.08k
...join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to anauthentic experience! The Grievance & Appeals Nurse is responsible for working directly with the IPAs, Hospitals, internal IEHP departments, and the grievance team to ensure...Remote jobTemporary workImmediate startFlexible hours- HealthEdge is seeking a Temporary A&G RN to independently process... ...SLA targets. You will investigate grievances, perform medical necessity reviews... ...settings, and prepare documentation for appeals in line with NCQA standards. Remote work from the US is supported, with...Remote jobContract workTemporary workWeekend work
- HealthEdge Software, Inc. is seeking a contract-based professional to manage complex grievances and appeals for members and providers in a remote US-based role. The candidate will review medical necessity across inpatient, outpatient, and ancillary services and prepare...Remote jobContract work
$52 - $56 per hour
...experience Type: Contract Location: 100% remote within the U.S. Schedule: Business hours... ...role: Investigate and manage clinical grievances, appeals, and external reviews from intake to resolution... ...: Active, unrestricted New York State RN license. 3+ years of progressive RN...Remote workContract workAfternoon shift- ...Appeals & Grievances Case Manager (Oregon) Immediate need for a talented Appeals & Grievances Case Manager (Oregon). This is a 12+ Months... ...opportunity with long-term potential and is located in US (Remote). Please review the job description below and contact me ASAP...Remote workContract workImmediate start
$81.1k - $116.48k
Appeals and Grievances Clinical Specialist - RN, LPN or Dental Hygienist - 100% Remote Join to apply for the Appeals and Grievances Clinical Specialist - RN, LPN or Dental Hygienist - 100% Remote role at Healthfirst . Position Summary: The Appeals & Grievances (A&G) unit...Remote jobFull timeMonday to FridayShift work- ...Network Health is seeking an Appeals and Grievance Specialist I to join our Wisconsin team. The role reviews member appeals, investigates findings... ...strong communication and regulatory interpretation skills. Remote 1.0 FTE, with occasional travel to offices in Menasha or...Remote work
- Inland Empire Health Plan is hiring a Grievance & Appeals Nurse in California. The role focuses on processing grievances and appeals per regulatory standards, coordinating with IPAs, hospitals, and IEHP teams to ensure timely, quality member care. The position requires...Remote work
- UnitedHealthcare is seeking a Clinical Grievances RN to work remotely in California. The role involves reviewing retrospective cases for appropriateness and ensuring member needs are addressed, with collaboration from Medical Directors and non-clinical partners. Remote...Remote jobMonday to Friday
$30.7k - $66.5k
...Medicare and Medicaid Services (CMS). Essential Job Duties • Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and related outside agencies to ensure that internal and/or regulatory...Remote workFull timeContract workWork at office- Centene Corp. is seeking a remote Grievance & Appeals Coordinator II for Centene Pharmacy Services. You will analyze and resolve member and provider grievances and appeals, coordinating with internal teams and health plan partners, while ensuring regulatory compliance....Remote job
- Humana, Inc. seeks a Grievances & Appeals Representative 2 to manage denials and concerns by conducting analytic review of clinical documentation and delivering final determinations in coordination with clinical partners. The role supports members and providers by addressing...Remote job
- Banner Plans & Networks in Arizona seeks a Grievance and Appeals Coordinator to manage the intake, review, investigation, and resolution of member grievances, appeals, and provider disputes in a remote setting. Candidates must reside in Arizona; you will document findings...Remote job
- Humana, Inc. is seeking a Grievances & Appeals Representative to manage denials and concerns by analyzing clinical documentation and applying policies to determine if an appeal is warranted. The role supports members and providers by addressing issues, resolving concerns...Remote job
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