Remote Appeals & Grievances Specialist (RN/LPN/DH)
Healthfirst
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 issues, and ensuring compliance with regulations. Ideal candidates should have experience in clinical practice and knowledge of Utilization Review Guidelines. The position offers a competitive salary and an opportunity to work with a dynamic team. #J-18808-Ljbffr
$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$81.1k - $116.48k
Position Summary: The Appeals & Grievances (A&G) unit manages Healthfirst member... ...manner. The A&G Clinical Specialist is the subject matter... ...providers. This position is 100% Remote. We are hiring for the... ...Minimum Qualifications: RN, LPN OR Dental Hygienist Preferred...Remote jobContract workTemporary workWork experience placementLocal areaMonday to FridayShift work- Moda Health is seeking a motivated professional to investigate and respond to medical, pharmacy and dental grievances, complaints, and appeals. This is a full-time work-from-home position within Government Programs. Responsibilities include thorough case review, timely...Remote jobFull timeWork from home
- ...To support a growing remote team, the full-time Appeals and Grievance Specialist will manage and resolve complaints, grievances, and appeals from members and providers while ensuring compliance with applicable requirements. Key responsibilities Manage and resolve complaints...Remote workFull time
$95k - $115k
Western Health Advantage seeks an Appeals & Grievances Nurse (RN) for their Utilization Management team in Sacramento, CA. This full-time role offers a salary between $95,000 and $115,000 annually. The nurse will collaborate with various stakeholders to ensure compliance...SuggestedFull time$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 UM, Appeals...Remote workHourly payFull timeContract workWork experience placementWork at office$70k - $80k
...Piper Companies is seeking a Remote Clinical Appeals Analyst to provide clinical expertise in reviewing and resolving complex member and provider... ...must hold an active North Carolina licensure as an RN, LPN, PT, or OT and have significant clinical experience. The salary...Remote workFull timeContract workMonday to Friday- Medix is seeking an LPN/LVN or RN with 1-2 years of appeals experience and clinical acute care background for a remote, full-time role. Training is 9am-4pm EST, with flexible start/end times to complete a 40-hour week, Monday through Friday. The position supports complex...Remote jobFull timeMonday to FridayFlexible hours
- Providence Health & Services is seeking an Appeals RN in Case Management for a remote, per diem role working 8-hour day shifts. The Care Management Recovery Advocate will manage clinically-based appeals between Providence California Region and outside payers, focusing...Remote jobDaily paidDay shift
- UnitedHealthcare is seeking a Clinical Appeals RN to provide expertise in appeals and grievances, serving as a Clinical Interface Liaison with facilities, providers, and carriers. The role allows remote work from anywhere in the U.S., with a schedule of M-F 8:00-4:30 and...Remote job
- ...Group in the United States is seeking a healthcare appeals specialist. The role requires an active RN or LPN license, a 40-hour work week, Monday to Friday, with mandatory holiday and weekend rotations. Fully remote opportunities are available to applicants in any U.S...Remote jobMonday to Friday
$102.18k
...Supervisor, Appeals and Grievances Clinical Operations RN Job Category: Clinical Department: Appeals & Grievances Location: Los Angeles, CA, US, 90017... ...requires work after hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in hours/shift in...Remote workFull timeShift workWeekend work$71.59k - $116.48k
...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... .... The ideal candidate should be an RN, LPN or Dental Hygienist with experience in appeals...Remote job- Ampcus Inc. is seeking a Utilization Management Specialist (Remote) to review medical necessity and authorization for clinical services. The role emphasizes clinical nursing expertise, care management experience, and adherence to guidelines and policies. The position requires...Remote job
$21.16 - $38.37 per hour
A healthcare provider is seeking a Medicare Appeals & Grievances Specialist to handle member appeals and grievances. This remote position requires strong experience in managed care, particularly with Medicare regulations. Ideal candidates will have excellent attention...Remote jobHourly payWork at office$45.9k - $78.6k
...a community of connected care, where coordinated, quality service is the norm and every member feels valued. Medica's Appeals and Grievance Specialist plays a vital role in ensuring our members and providers receive clear, timely, and accurate resolutions to their concerns...Work experience placementWork at office3 days per week- ...Appeals and Grievance Specialist II (Managed Care) – Irving, TX | 12-Week Contract Location: Irving, TX Job Type: 12-Week Contract Company: Sigma Inc. Schedule: Monday–Friday | 8-Hour Shifts Join Our Team as an Appeals and Grievance Specialist II! Sigma Inc....Contract workMonday to FridayShift work
- Santa Barbara Cottage Hospital is seeking a Grievance and Appeals Nurse for a remote position based in Indiana. Responsibilities include investigating complex... ...need at least 2 years in managed care and an IN RN license, with MCG experience and preferred CMCN. #J-188...Remote job
$65k - $75k
...If you want to use your talents to transform healthcare in the United States, come join us! About the Role As an Appeals and Grievances Specialist, you'll own the end-to-end handling of member and provider appeals and grievances, investigating cases, coordinating with...$30.5 - $41 per hour
...Cardiovascular Medicine, PLLC is seeking a Registered Nurse (RN) or Licensed Practical Nurse (LPN) to join our Device Clinic team. If you have strong... ...limited patient assessments. Processing and scheduling remote device checks. Handle telephone triage of incoming...Remote workWork at officeLocal areaMonday to FridayWeekend work$30 - $35 per hour
...Now Hiring: Grievance & Appeals Specialists Are you an experienced Grievance & Appeals professional with a background in Medicare or Medicaid Managed Care? We're partnering with a leading healthcare organization that's looking to add multiple specialists to their growing...Work at officeImmediate start- Healthfirst is seeking an A&G Clinical 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...Remote work
- A national recruiting company is seeking a Business Grievance/Appeals Representative in Cerritos, California. The ideal candidate will review, analyze, and process claims, conduct investigations into customer grievances, and ensure proper communication with customers. Candidates...Contract work
- MJHS seeks an A&G Specialist in New York, NY to handle department correspondence, log and route mail, and provide back-up support... ...and the director. The role emphasizes timely processing of grievances and appeals within regulatory timeframes. Responsibilities include opening...
- UnitedHealth Group, through OptumCare, seeks a qualified professional to manage Medicare reconsiderations, grievances, and appeals, coordinating with CMS and internal stakeholders. You will help ensure CMS regulatory compliance and drive timely resolutions. The role requires...
- Medica, a nonprofit health plan, is seeking a remote Appeals & Grievances Clinical Specialist III to review and resolve appeals and grievances with clinical... ...and clinical staff. This position requires an active RN license and 5+ years of clinical experience, preferably...Remote job
- ...Appeals And Grievance Specialist II This position requires the ability to work independently researching and reviewing inquiries from members and providers. Also requires knowledge of benefit interpretation, claims reviews, CPT and ICD coding. Responsible for reviewing...
- UnitedHealth Group is seeking a Clinical Appeals RN to analyze appeals and grievances, acting as a clinical interface liaison with facilities, providers, and carriers. Remote work is offered across the U.S. with a M-F schedule and alternating Saturdays. Responsibilities...Remote job
- ...Unit Manager (RN or LPN) Looking for qualified Unit Manager (RN or LPN) to join our team... ...Work with families and staff to address grievances and maintain resident rights. Assist... ...adults. From telemedicine services and remote health monitoring to advanced diagnostic...Remote workFull timeLocal areaMonday to FridayShift workNight shiftDay shiftAfternoon shift
- A national recruiting company is seeking a Grievance/Appeals Representative in Thousand Oaks, CA. The role involves reviewing claims, investigating customer grievances, and ensuring resolution of appeals. Candidates must possess a high school diploma and have 1 to 3 years...Contract work
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