Manager, Member Appeals & Grievances (Hybrid Remote)
L.A. Care Health Plan
- Remote job
A leading health care provider in Los Angeles is seeking a Manager, Appeals and Grievances. This full-time position involves overseeing the intake, logging, and resolution of member appeals and grievances. The ideal candidate should have extensive experience in health care dispute resolution and management. Responsibilities include establishing compliance processes, collaborating with multiple internal departments, and leading a dedicated team. A Bachelor's Degree is required, alongside strong analytical and communication skills. Competitive salary with various benefits is offered. #J-18808-Ljbffr L.A. Care Health Plan
$88.85k
...Manager, Appeals and Grievances Job Category: Customer Service Department: CSC Appeals & Grievances... ...plan. Serving more than 2 million members, we make sure our members get the right... ...hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in...Remote workFull timeFor contractorsShift workWeekend work- ...JOB DESCRIPTION Job Summary Leads and manages team responsible for claims activities including reviewing and resolving member and provider complaints, and... ...submission/resolution of member and provider appeals and grievances; ensures resolutions are compliant with...Remote workWork at office
- L.A. Care Health Plan is hiring an Appeals and Grievances Nurse Specialist RN II in Los Angeles. This role involves assisting members with healthcare access issues and resolving complaints... ...California RN. The position offers a hybrid work schedule and a variety of benefits...Remote job
$20 - $30 per hour
...Immediate need for a talented Case Manager – Appeals & Grievances (California) . This is a 06+ months contract... ...and is located in California (Remote). Please review the job description below... ...investigate, coordinate, and resolve member complaints, grievances, and appeals...Remote workContract workLocal areaImmediate start- ...Care Health Plan is seeking an Appeals and Grievances Specialist II in Los Angeles... ...role involves investigating member and provider complaints,... ...include at least 2 years in Managed Care, knowledge of medical terminology... ...full-time position offers a hybrid work schedule and a...Remote jobFull time
- ...OH 44144, USA Description A hybrid role requiring 4 days per week... ...of the Brooklyn, Ohio office. Manages staff and end‑to‑end operations for member and provider appeals and claim review. Ensures compliance... .... Whether you are working remote or in the office, employees...Remote workWork at office
$20 - $26 per hour
Creative Solutions Services, LLC is seeking a talented Case Manager - Appeals & Grievances for a 6+ month contract opportunity in California. This role involves investigating and resolving member complaints and grievances while ensuring compliance with health plan standards...Remote jobHourly payContract work- ...Central Credit Union seeks a Call Center Manager in Phoenix, Arizona to lead and... ...degree, and the ability to foster strong member relationships. The role includes... ...preparing KPI reports. The position offers a hybrid work model with remote work available post-90 days, ensuring...Remote job
$30 - $35 per hour
...seeking a Mid-Senior Level professional for a contract role to manage grievances and appeals. Candidates should have 6+ years in customer service with... ...range of $30.00/hr - $35.00/hr based on qualifications. Remote work is available for candidates within 100 miles of...Remote workContract workFor contractors- ...activities including reviewing and resolving member and provider complaints, and... ...comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina... ...Qualifications • At least 2 years of managed care experience in a call center, appeals...Remote workContract workWork at office
- ...TN, seeks a Call Center Team Lead for Member Services. This position involves managing call center performance, ensuring customer... ...knowledge in healthcare services. A hybrid work schedule is available, blending in-office and remote work, along with an emphasis on team leadership...Remote workWork at office
$66.24k - $86.11k
Care Manager II (Full Time Hybrid- Must be NC based) Job Category : Care Management... ...among care team members and is the primary point... ...rights, explanation of the grievance and appeals process, available service... ...schedules including hybrid/remote options. Paid time off including...Remote workFull timeWork at officeHome officeFlexible hours$68.23k - $88.7k
...Description The Care Manager II position leads all... ...communication among care team members and is the primary... ...This is a full-time hybrid opportunity. There is... ..., explanation of the grievance and appeals process, available... ...including hybrid/remote options Paid time off...Remote workFull timeWork at officeHome officeFlexible hours- ...seeking a Membership Care and Growth Manager to engage and advocate for patients joining... ...ensuring a supportive and positive member experience. The ideal candidate is... ...committed to health outcomes. This hybrid role involves both remote and in-clinic responsibilities across...Remote work
$40k - $52.3k
...Grievances & Appeals Representative 2 You will report to the... ...have proactive queue management, attention to changing... ...outbound calls to members or providers to request... ...To ensure Home or Hybrid Home/Office employees... ...Travel: While this is a remote position, occasional...Remote workBi-weekly payHourly payTemporary workApprenticeshipWork at officeWork from homeHome officeMonday to Friday$246.1k - $344.2k
...decisions on complex appeal cases, exercising... ...and resolve grievances and appeals. Participate... ...regulations, managed care requirements,... ...To ensure Home or Hybrid Home/Office associates... ...to protect member PHI / HIPAA information... ...This is a remote position anywhere...Remote workBi-weekly payFull timeTemporary workApprenticeshipInterim roleWork at officeWork from homeHome officeMonday to Friday$79.78 - $120.46 per hour
...employees. As a Senior Manager of People Services,... ...others. This is a hybrid role that requires occasional... ...role may work from remotely. All new... ...responding to and resolving grievances, and labor contract... ...interface with staff members possessing a variety of...Remote workContract workWork at officeLocal area$77.87k - $99.28k
The Vendor Relations Manager is responsible for overseeing... ...serving Alliance members under delegated agreements... ...delivery. This position is hybrid with ability to work three days remote. On Tuesday and... ...related to member or provider grievances and complaints to the delegated...Remote workFull timeContract workTemporary workHome officeFlexible hours$25.75 - $32.83 per hour
...The Member and Recipient Services Coordinator provide... ...position is full-time remote. Selected candidate must... ...General information about managed care and NC Medicaid... ...care management entities; Grievance and complaint... ...work schedules including hybrid/remote options Paid time...Remote workHourly payFull timeHome officeFlexible hours- ...We are hiring an Appeals & Grievance Nurse Analyst at BCBST! In this role... ...process appeals submitted by members and providers, ensuring timely... ..., determine next steps, and manage multiple priorities while... ...Note • This is a fully remote role with a 40-hour workweek...Remote workShorter hoursWork at officeWork from homeRelocation package
- Atlas Copco Holding GmbH is seeking a Customer Service Manager in Rock Hill, SC to oversee a team and ensure... ...communication and problem-solving skills. This role offers a hybrid working arrangement—4 days in office, 1 day remote—along with a culture of trust, innovation, and...Remote workWork at office
$70.2k - $120.4k
Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin... ...is the norm and every member feels valued. Medica’s Appeals and Grievances Manager supports the day‑to‑day operations of the Appeals and Grievances...Work experience placementWork at office3 days per week$102.18k
...Customer Solution Center Appeals and Grievances RN Job Category: Clinical... ...Serving more than 2 million members, we make sure our members... ...and may provide feedback to management on performance of staff.... ...on weekends, holidays, a hybrid remote schedule, and occasional flexibility...Remote workFull timeShift workWeekend work- ...Role: Senior Manager Location: Philadelphia (Hybrid) Experience: 5+ years Full Time Role Role Overview We are looking for... ...ensure model relevance and impact. Mentor junior team members and drive best practices in statistical modeling and...Remote workFull time
$88.85k
...Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department... ...more than 2 million members, we make sure our members get... ...in Medicare/ Medicaid in a managed care/ health plan environment... ..., on weekends, holidays, a hybrid remote schedule, occasional...Remote workFull timeShift workWeekend work$67.19k
...Serving more than 2 million members, we make sure our members... ...purpose. Job Summary The Appeals and Grievances (A&G) Quality Assurance (QA... ...Compliance, Training and QA Manager to develop a successful and... ..., on weekends, holidays, a hybrid remote schedule, occasional flexibility...Remote workShift workWeekend work- ...At AZ Blue, we have a hybrid workforce strategy, called... ...classified as hybrid, onsite or remote. While the majority of our... ...clinical acumen and managed care expertise related to... ...responding to requests for member and provider appeals, grievances, reconsiderations and corrected...Remote workFull timeContract workWork experience placementWork at officeLocal area1 day per week
$18 - $24 per hour
...Responsibilities: Triaging incoming appeals and grievances, categorizing them appropriately, and assigning... .../voicemails. Handling standard member appeals for pre-service pharmacy coverage for non-Medicare products. Managing case load of approximately 40 cases at...Remote work$60.78k
Appeals and Grievances Specialist II Job Category: Customer Service Location... ...Serving more than 2 million members, we make sure our members... ...Services (DHCS), Department of Managed Health Care (DMHC), Managed... ..., on weekends, holidays, a hybrid remote schedule, occasional...Remote workFull timeLocal areaShift workWeekend work$105.5k - $158.23k
...Position Overview: ~ Manager, Contracts, is responsible for facilitating and managing... ...able to collaborate effectively as a key member of different teams to achieve optimal... ...Information ~ This position is eligible for hybrid working arrangements and requires on-site...Remote workContract workShift work
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