Remote Appeals & Grievances Clinical Manager
GlobalHealth, Inc.
- Remote job
GlobalHealth, Inc. seeks a daily clinical leader to ensure compliance and timely handling of Appeals and Grievances. You will oversee scheduling, escalation management, and staff coaching while maintaining HIPAA safeguards and reporting essentials. Required are LPN or higher credentials, 3 years in A&G operations, 2 years in appeals/grievances, and proficiency with MS Office; Power BI, Mitel, and Epic are a plus. Remote work with limited travel may apply. #J-18808-Ljbffr GlobalHealth, Inc.
- ...a Corporate Medical Director to provide clinical interpretation and make determinations regarding... ...judgment on complex issues across grievance and appeal reviews, with emphasis on Medicare, Medicaid, and Commercial products. Remote work with occasional travel is possible....Remote work
- ...UnitedHealthcare is seeking an Appeals and Grievances Medical Director to oversee clinical review and adjudication of appeals... ...improvement while enabling remote work from anywhere in the U.S. The... ...and substantial clinical and quality management experience. #J-18808-LjbffrRemote work
$111.03k - $161.93k
...hiring an Associate Director, Appeals & Grievances to join our team. Oscar is... ...oversight for Oscar's non-clinical Administrative CGA and Elite... ...Work Location: This is a remote position, open to candidates... ...Develop a multi-tiered team of managers, lead, and specialists using...Remote workFull timeWork from homeHome office$107.7k - $199.3k
...Purpose: Responsible for oversight of member appeals and grievance processes. Directs and ensures the efficient operational management of appeals and grievance departments/... ...holidays, and a flexible approach to work with remote, hybrid, field or office work schedules....Remote workFull timePart timeWork at officeFlexible hours$248.5k - $373k
...00/yearJob Area: Medical & Clinical OperationsCompany: UnitedHealth... ...together. Work at home!The Appeals and Grievances Medical Director is... ...enjoy the flexibility to work remotely * from anywhere within the... ...of Insurance/Department of Managed Healthcare, and CMS regulatory...Remote workMinimum wageFull timeWork experience placementLocal areaWork from home- 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
$246.1k - $344.2k
...of medical records for appeals decisions. The... ...Medical Director provides clinical interpretation and makes... ...oversee clinical reviews of grievance and appeal cases for... ...reflect knowledge of managed care operations,... ...Work Style: Fully remote living in the contiguous...Remote workFull timeTemporary workApprenticeshipWork at officeWork from homeHome officeMonday to FridayWeekend 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
$42.2k - $65.96k
The Appeals and Grievances Clinical Coordinator is responsible for supporting the clinical team to ensure timely and accurate processing of cases... ...changes WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations...Full timeTemporary workWork experience placementWork at officeFlexible hours- ...Analyzing and resolving grievances and appeals, the full-time remote Grievance & Appeals Coordinator II will handle member and provider complaints while... ...experience in claims, contracting, or a related role within a managed care environment Experience in investigating and...Remote workFull time
- Centene Corporation is seeking a Grievance & Appeals Manager to ensure timely processing of member and provider appeals and state fair hearing requests. The role is remote with PST hours and a strong preference for an Oregon-resident candidate with an active Oregon RN...Remote job
- A staffing solutions company is seeking a Grievance & Appeals Coordinator for a fully remote position in Detroit, MI. This role involves processing appeals, grievances, and inquiries while maintaining accurate documentation and effective communication. The ideal candidate...Remote jobContract work
- 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
- HealthEdge is seeking a remote (US) Appeals & Grievances Specialist to independently process complex grievances and conduct medical necessity reviews... ...an unrestricted USRN license, 2+ years in utilization management, and strong written/verbal communication. #J-18808-...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...Remote jobFlexible hours
- Centene Corp. is seeking a remote Grievance & Appeals Coordinator II for Centene Pharmacy Services. You will analyze and resolve member and provider... ...and oral communication, with at least two years in a managed care setting; pay range is stated and remote work options...Remote job
- 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 and...Remote job
$40k - $52.3k
Grievances & Appeals Representative The Grievances & Appeals Representative 2 manages client denials and concerns by conducting a comprehensive analytic review of clinical documentation to determine if an a grievance... ...Travel: While this is a remote position, occasional...Remote workTemporary workWork at officeWork from homeHome officeMonday to FridayShift work- Humana, Inc. in the United States seeks a Grievances & Appeals Representative to support members and providers with grievances and appeals, investigating... ...policies to determine appropriate resolutions. In a remote-friendly environment, you will document interactions,...Remote job
- Harbor Health in Texas seeks an Appeals & Grievances Specialist to investigate, process, and resolve member and provider complaints, grievances, and appeals. This fully remote role focuses on Texas IFP/Marketplace and large-group products, ensuring timely investigations...Remote job
- Humana, Inc. is seeking a Grievances & Appeals Representative to assist members and providers with grievance and appeal inquiries, investigate... ...role supports quality and member experience goals within a remote, production-driven environment. Typical duties include applying...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 to determine if criteria are met. The role requires California... ...RN/LPN licensing and supports remote work with PST hours....Remote job
- 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... ...and PST hours for remote work. You will review clinical data, overturn or uphold denials per NCQA...Remote job
- Centene Corporation is seeking a Grievance & Appeals Coordinator in the United States. The role ensures timely processing of member grievances and provider appeals, serving as the primary State contact and overseeing day-to-day operations of the Grievance & Appeals team...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
- 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
$53 per hour
REMOTE RN OPPORTUNITY - GRIEVANCE & APPEALS / UTILIZATION REVIEW We're hiring experienced Registered Nurses to join... .... Strong outpatient Utilization Management experience Experience with prior... ...Medicare/Medicaid experience Strong clinical judgment and communication skills...Remote jobLong term contractMonday to Friday$73.01k - $111.97k
...responsible for the submission/resolution of member and provider appeals and grievances, and ensures resolutions are compliant with applicable... ...Qualifications • At least 4 years of operational managed care experience in a call center, appeals, and/or claims environment...Remote workFull timeWork at office- 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
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