Medicare Grievance & Appeals Nurse - Remote
Apolis
- Remote job
Apolis is seeking a Grievance and Appeals RN in Phoenix, AZ (or remote within AZ time zone) to review and investigate member and provider grievances and appeals for Medicare Part C and Part D. The nurse reviews medical records, claims, authorizations, and plan benefits to make determinations in accordance with CMS requirements and timelines. The role requires an active Arizona nursing license (RN or LPN), a healthcare degree, and at least 5 years in grievances/appeals, prior authorization, #J-18808-Ljbffr Apolis
- ...ü Technology Partners is seeking a Med Appeals & Grievance Specialist Coordinator (Clinical) for a... ...prior authorizations. Must be a licensed nurse with strong clinical and analytical... ...coordinating with internal departments. Remote work is available; schedule 8:00-4:30 Mountain...Remote jobContract work
- 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
- ...Grievance & Appeals Coordinator Are you a detail-oriented managed care professional looking for an exciting work-from-home opportunity in Iowa? We are seeking a self-motivated, organized Grievance & Appeals Coordinator to join our dynamic team! In this essential role...Remote workWork from home
- ...Grievance & Appeals Coordinator Are you an analytical problem solver with a passion for healthcare managed care? We are seeking dedicated... ...Coordinators to join our growing, collaborative team! In this fully remote role, you will analyze and resolve complex member and...Remote workWork from homeHome officeWeekend work
$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... ...44 and 49 PHL), InterQual, Milliman, or Medicare guidelines. Proficiency with Microsoft...Remote jobFull timeMonday to FridayShift work$81.1k - $116.48k
Position Summary: The Appeals & Grievances (A&G) unit manages Healthfirst member complaints, grievances... ...providers. This position is 100% Remote. We are hiring for the following... ...4 and 49 PHL), InterQual, Milliman or Medicare local coverage guidelines. Ability to...Remote jobContract workTemporary workWork experience placementLocal areaMonday to FridayShift work$21.16 - $38.37 per hour
...Join to apply for the Medicare Appeals & Grievances Specialist (PST Hours) role at Molina Healthcare . This position is remote and will be working Pacific Standard hours. Highly Qualified Candidates Will Have The Following Experience Strong understanding of...Remote workHourly payFull timeContract workWork experience placementWork at office- WPS Health Solutions in Columbus, OH, is seeking an Appeals Nurse to review medical records and Medicare claims for first-level appeals to determine medical necessity and coverage alignment. The role collaborates with Appeals Examiners to prepare timely redeterminations...Remote job
- CVS Health is recruiting an Appeals Nurse Consultant to process medical necessity for Medicare Part C appeals. The role combines independent and team work in a remote setting, with a 40-hour weekly schedule and occasional weekend/holiday rotations. Required RN licensure...Remote job
- ...Specialist to lead the development and resolution of clinical cases for member and provider appeals, ensuring compliance with applicable laws and internal policies. The role can be remote or on-site at the NYC or Lake Mary locations, with travel as needed. You will manage...Remote work
$248.5k - $373k
.... Growing together.Work at home!You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities:The Appeals and Grievances Medical Director is responsible for ongoing clinical review and adjudication...Remote workMinimum wageWork experience placementLocal areaWork from home- ...Role Snapshot The Appeals Nurse examines medical records and claims information for first-... ...provided were medically necessary and meet Medicare coverage guidelines in accordance with... ...experience. Work Location We are open to remote work in the following approved states:...Remote workContract workFor contractorsLocal areaImmediate start
$71.59k - $116.48k
A prominent healthcare organization is seeking an A&G Clinical Specialist to manage health member complaints and appeals. This fully remote position requires expertise in clinical case management, understanding of regulatory compliance, and the ability to effectively resolve...Remote job- CVS Health in the United States is seeking an Appeals Nurse Consultant to evaluate Medicare Part C medical necessity for members and providers. This role... ...blends independent action with team collaboration in a remote setting. The position features a 40-hour work week, weekend...Remote jobWeekend work
- CVS Health is seeking an Appeals Nurse Consultant to review and determine medical necessity for Medicare Part C appeals from members and providers. This production role requires... ..., and the ability to work independently in a remote, fast-paced environment. Typical schedule...Remote jobWeekend work
- Overview Job Title: Registered Nurse - Claims & Appeals Review Location: Remote (Anywhere in Florida) Duration: 06 Months/Can be Extended Working hours:... ...field preferred 2+ years of experience in appeals, grievance, or quality assurance in a healthcare setting Experience...Remote workContract workDay shift
- CVS Health in Idaho is seeking an Appeals Nurse Consultant to process the medical necessity of Medicare Part C appeals. This full-time role requires an active RN license... ...on safe, quality care. The role supports remote work within the U.S. time zones. #J-18808-Ljbffr...Remote jobFull timeWeekend work
$22.99 per hour
...analytical problem solver with a passion for healthcare managed care? We are seeking dedicated Grievance & Appeals Coordinators to join our growing, collaborative team! In this fully remote role, you will analyze and resolve complex member and provider appeals and grievances,...Remote workHourly payPermanent employmentTemporary workWork experience placementWork at officeWork from homeHome officeShift workWeekend work$19.76 per hour
...managed care professional looking for an exciting work-from-home opportunity in Iowa? We are seeking a self-motivated, organized Grievance & Appeals Coordinator to join our dynamic team! In this essential role, you will review incoming complaints, investigate complex...Remote workHourly payPermanent employmentTemporary workWork experience placementWork at officeWork from homeHome officeMonday to FridayShift workWeekend work$60.78k
...Appeals and Grievances Specialist II Job Category: Customer Service Department: Appeals & Grievances... ...in compliance with Centers for Medicare and Medicaid Services (CMS), California... ..., on weekends, holidays, a hybrid remote schedule, occasional flexibility in hours...Remote workFull timeLocal areaShift workWeekend work- ...Medica is seeking an Appeals and Grievance Specialist to manage member complaints, grievances, and regulatory inquiries, ensuring timely, accurate... ...Operations, Health Services, Legal, and Markets. This is a remote position with a competitive total rewards package. #J-1880...Remote work
$270.8k - $378.8k
...Director relies on fundamentals of CMS Medicare Guidance on following and reviewing appeals for Medicare Line of Business. The... ...closely with our Appeal Strategy, Nurse Leaders and adjacent stakeholders... ...Leadership Work Style: Fully Remote; Very minimal travel might be...Remote workFull timeTemporary workWork at officeWork from homeHome officeMonday to FridayShift work- 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
- ...seeking a clinical professional to join our Medical Management/Health Services team to ensure proper processing of member grievances, provider appeals, and state fair hearings. You will serve as the primary contact with the State and oversee the daily activities of the...Remote job
- Elevance Health is seeking a Grievance/Appeals Analyst I to join the Enterprise Grievance & Appeals Department. This entry level role reviews... ..., prepare written determinations, and collaborate with nursing, medical staff, and other internal teams. #J-18808-Ljbffr Elevance...Remote job
- Firstsource Healthcare is seeking a detail-oriented Claims & Appeals & Grievances (A&G) Specialist to join our Healthcare Operations team. The candidate should have at least two years of experience in US healthcare back-office operations with expertise in claims processing...Remote job
- ...Job Title Job Description Process appeals and grievances, analyze, research, and provide... ...and regulatory provisions. This is a Remote Role Experience Experience handling... ...fast-paced environment. Insurance, Medicare/Client knowledge Writing Letters...Remote workContract workApprenticeshipLocal area
$23.22 - $34.84 per hour
A leading health insurance provider is seeking a Grievance & Appeals Coordinator to work virtually full-time, with responsibilities including summarizing complaints, ensuring resolution of grievances, and documenting interactions. The ideal candidate should possess a high...Remote jobHourly payFull time$71.1k - $97.8k
...of our caring community The Part C Grievance & Appeals (G&A) Nurse (Utilization Management Nurse 2)... ...cases prior to review by the Humana G&A Medicare Medical Directors. You will review the... ...required holiday rotation. This is a remote position. This role is responsible...Remote workFull timeTemporary workApprenticeshipWork at officeWork from homeHome officeFlexible hoursWeekend workWeekday work- UnitedHealth Group's Optum is seeking a Utilization Management Nurse to review patient records and craft defensible appeal letters in accordance with OPAS guidelines. This role supports 40 hours per week, Monday-Friday, with telecommuting flexibility across the U.S. and...Remote jobMonday to Friday
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