Remote Appeals & Grievances Specialist (RN/LPN/DH)
Health First
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
- 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 hiring a licensed RN for a fully remote Grievances & Appeals contract opportunity with a leading healthcare organization across the United States. The role offers $55/hour, weekly pay, 9 AM-5 PM EST coverage, and equipment provided. You will review grievances...Remote jobWeekly payContract 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 - 100% Remote role at Healthfirst . Position Summary: The Appeals & Grievances (A&G) unit...Remote jobFull timeMonday to FridayShift work- ...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. Responsibilities include...Remote job
- ...York health plan. You will own clinical grievances and appeals from intake to final decision letters,... ...InterQual/MCG criteria. The position is 100% remote in the United States, with business... ...deadlines. Requires active NY RN license and payer-side experience. #J-...Remote jobContract workAfternoon shift
- ...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
- ...Acentra Health is seeking an Appeals and Grievance Specialist to join our growing team. You will conduct thorough research and investigations to resolve... ..., and ensure prompt completion of the process. This is remote with core hours in the Eastern Time Zone. Required: high...Remote work
$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$60.78k
...Appeals and Grievances Specialist IIJob Category: Customer Service Department: Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position Type... ...work after hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in hours/shift in critical...Remote workFull timeLocal areaShift workWeekend work$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...Remote workFull timeContract workWork at officeWeekend work- 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
- Banner Health is seeking a Health Plans Grievance and Appeals Coordinator in a remote role. You will manage grievances, appeals, and disputes for members and providers, ensuring timely investigations and communications. The role requires knowledge of AHCCCS, HCG, CMS rules...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
- Centene Corp. is seeking a Grievance & Appeals Coordinator I for a remote KS role. You will analyze and resolve member and provider grievances and appeals, prepare formal responses, and maintain detailed case files in a fast-paced environment. The role requires a high...Remote jobFlexible hours
- Humana, Inc. is seeking a Grievances & Appeals Representative to manage member and provider inquiries, investigate concerns, and deliver timely... ...application, and collaboration across teams in a primarily remote setting. The position requires prior customer service...Remote jobMonday to FridayShift work
- Humana, Inc. is seeking a Grievances & Appeals Representative 2 to manage client denials and concerns by conducting analytic reviews of clinical... ...determinations in a production-driven environment. This remote role supports members and providers, applying Humana policies...Remote jobMonday 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 UM, Appeals...Remote workHourly payFull timeContract workWork experience placementWork at office- 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
- Job Category Appeals, Grievances, Specialist Employee Type Exempt - FT Manage Others No Contact information Phone (***) ***-**** Email ****@*****.***... ...provider complaints, grievances, and appeals. This fully remote position focuses primarily on supporting our Texas fully...Remote workHome office
$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- 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 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
- ...expertise and dedication. Paid Time Off Job Summary The Appeal Specialist II reviews, analyzes, and resolves insurance denials to ensure... ...software and Google Suite. Licenses and Certifications RN - Registered Nurse - State Licensure and/or Compact State...Remote workFull timeContract workWork at office
$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- 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
$52 - $56 per hour
...RN Grievance & Appeals Specialist Remote Contract RNs with direct payer-side Grievance & Appeals experience this opportunity is for you. Were seeking an RN who has personally managed clinical grievances and appeals from investigation through the final determination...Remote workContract workAfternoon shift- 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
$66k - $68k
WPS, a health solutions company, seeks an Appeals Nurse to review first-level appeal cases, assess medical necessity, and prepare rationale... ...and communication skills are essential. The role offers remote work options across approved states, with a base salary in the...Remote job$52 - $56 per hour
...Job Description Job Description 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 letter? We want to talk to you. Our client, a New York health plan, needs...Remote jobContract workImmediate start$56.27k - $69.9k
Pay Plan Title: Appeals or Grievances Specialist II Working Title: Appeals Specialist II FLSA Status: Exempt Posting Salary Range: $56,270 - $69,898 Office Location: Remote within North Carolina POSTING DETAILS: Make an Impact Trillium Health Resources is...Remote workFull timeWork at officeLocal areaImmediate startWork from homeFlexible hours
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