Sign up to access all features of our service.
  • Job search
  • Favorites
  • Create a CV
    New
  • Salaries
  • Subscriptions

Remote Medical Appeals & Grievances Director

Unitedhealthcare

UnitedHealthcare is seeking an Appeals and Grievances Medical Director to oversee clinical review and adjudication of appeals and grievances across multiple health plans. The role supports regulatory responses, collaborates with medical directors, and drives quality improvement while enabling remote work from anywhere in the U.S. The position requires an MD or DO with active licensure, Board Certification, and substantial clinical and quality management experience.

#J-18808-Ljbffr
Vacancy posted 1 day ago
Similar jobs that could be interesting for youBased on the Remote Medical Appeals & Grievances Director in Sylacauga, Talladega County, AL vacancy
  • $111.03k - $161.93k

     ...'re Oscar. We're hiring an Associate Director, Appeals & Grievances to join our team. Oscar is the first...  ...Programs. Work Location: This is a remote position, open to candidates who...  ...are eligible for benefits including: medical, dental, and vision benefits, 11 paid... 
    Remote work
    Medical
    Full time
    Work from home
    Home office

    Oscar Health

    Florida
    3 days ago
  • $107.7k - $199.3k

     ...Position Purpose: Responsible for oversight of member appeals and grievance processes. Directs and ensures the efficient operational management...  ...off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be... 
    Remote work
    Full time
    Part time
    Work at office
    Flexible hours

    Centene Corporation

    Florida
    8 days ago
  •  ...Analyzing and resolving grievances and appeals, the full-time remote Grievance & Appeals Coordinator II will handle member and provider complaints while...  ...teams and subject matter experts to prepare cases for medical review and determine outcomes Serve as a liaison between... 
    Remote work
    Medical
    Full time

    Virtual Vocations Inc

    United States
    4 days ago
  •  ...Humana, Inc. is seeking a Corporate Medical Director to provide clinical interpretation and...  ...independent judgment on complex issues across grievance and appeal reviews, with emphasis on Medicare, Medicaid, and Commercial products. Remote work with occasional travel is... 
    Remote work
    Medical

    Humana

    Dover, DE
    1 day ago
  • HealthEdge is seeking a remote (US) Appeals & Grievances Specialist to independently process complex grievances and conduct medical necessity reviews across inpatient, outpatient, and...  ...standards and coordinate with Medical Director for case outcomes. Ideal candidates have... 
    Remote job
    Medical

    HealthEdge

    New York, NY
    5 days ago
  • 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...  ...review cases, prepare submissions for the Medical Director, and ensure NCQA-compliant communication with... 
    Remote job
    Medical
    Flexible hours

    Centene Corp.

    New York, NY
    6 hours ago
  •  ...LLC is seeking a nurse to facilitate medical necessity grievances, appeals and denials while reviewing clinical...  ...RN/LPN licensing and supports remote work with PST hours. Responsibilities...  ...preparing case reviews for the Medical Director and generating appeal communications... 
    Remote job
    Medical

    Centene Management Company LLC

    Sacramento, CA
    1 day ago
  •  ...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...  ...case reviews for the Medical Director, coordinating with providers, and ensuring... 
    Remote job
    Medical

    Centene

    Sacramento, CA
    1 day ago
  • 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...  ...case reviews for the Medical Director, and ensure adherence to NCQA guidelines... 
    Remote job
    Medical

    Centene Corp.

    Sacramento, CA
    1 day ago
  • 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...  ...guidelines, and prepare case materials for Medical Director review, while identifying care concerns and... 
    Remote job
    Medical

    Centene Corp.

    Sacramento, CA
    1 day ago
  • $53 per hour

    REMOTE RN OPPORTUNITY - GRIEVANCE & APPEALS / UTILIZATION REVIEW We're hiring experienced Registered Nurses to join a leading healthcare organization in...  ...Management experience Experience with prior authorizations and medical necessity reviews Grievance & Appeals experience... 
    Remote job
    Medical
    Long term contract
    Monday to Friday

    Phaxis - Healthcare

    Huntington, NY
    16 hours ago
  • $73.01k - $111.97k

     ...responsible for the submission/resolution of member and provider appeals and grievances, and ensures resolutions are compliant with applicable...  ...and experience. • Experience reviewing all types of medical claims (e.g. HCFA 1500, Outpatient/Inpatient UB92, Universal... 
    Remote work
    Medical
    Full time
    Work at office

    Molina Healthcare

    Remote
    8 days ago
  • HealthEdge Software, Inc. is seeking a contract-based professional to manage complex grievances and appeals for members and providers in a remote US-based role. The candidate will review medical necessity across inpatient, outpatient, and ancillary services and prepare... 
    Remote job
    Medical
    Contract work

    HealthEdge Software, Inc.

    New York, NY
    6 hours ago
  •  ...nurse to investigate and manage clinical grievances, appeals, and external reviews from intake to...  .... The role emphasizes reviewing medical necessity, quality-of-care concerns, and...  ...deadlines. You will collaborate with Medical Directors, draft determination letters, and... 
    Remote job
    Medical

    Phaxis

    New York, NY
    4 days ago
  • $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...  ..., and experience with prior authorizations and medical necessity reviews. #J-18808-Ljbffr Phaxis - Healthcare
    Remote job
    Medical
    Long term contract
    Contract work
    Monday to Friday

    Phaxis - Healthcare

    Huntington, NY
    6 hours ago
  • Phaxis is hiring a Remote UM / Grievance & Appeals RN (NY License) for a contract role with a New York health plan. If you have owned appeals from...  ...decision letter, we want to talk to you. You will review medical necessity for outpatient and community-based services, draft... 
    Remote job
    Medical
    Contract work

    Phaxis

    New York, NY
    1 day ago
  •  ...output quality and adherence to SLA targets. You will investigate grievances, perform medical necessity reviews across care settings, and prepare documentation for appeals in line with NCQA standards. Remote work from the US is supported, with potential weekend hours as... 
    Remote job
    Medical
    Contract work
    Temporary work
    Weekend work

    Wellframe

    New York, NY
    1 day ago
  • Centene is seeking a remote Grievance & Appeals Coordinator II to analyze and resolve member and provider complaints and appeals. The role supports...  ...grievances within regulations, preparing cases for medical review, and coordinating with internal teams and health plan... 
    Remote job
    Medical

    Centene

    New York, NY
    6 hours ago
  • $30.7k - $66.5k

     ...• Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and related...  ...appeals and grievance outcomes. • Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates... 
    Remote work
    Medical
    Full time
    Contract work
    Work at office

    Molina Healthcare

    Ohio
    1 day ago
  • $52 - $56 per hour

    Now hiring: Remote UM / Grievance & Appeals RN (NY License) | Contract | $52-56/hr Are you an RN who has...  ...background. You’ll review medical necessity for outpatient and community...  .... You’ll also work with the Medical Director, write determination letters, and prepare... 
    Remote job
    Medical
    Contract work
    Immediate start

    Phaxis

    New York, NY
    1 day ago
  • $246.1k - $344.2k

     ...community The Corporate Medical Director relies on medical background...  ...reviews of medical records for appeals decisions. The Corporate...  ...oversee clinical reviews of grievance and appeal cases for assigned...  ...specialists Work Style: Fully remote living in the contiguous USA... 
    Remote work
    Medical
    Full time
    Temporary work
    Apprenticeship
    Work at office
    Work from home
    Home office
    Monday to Friday
    Weekend work

    Humana

    Remote
    7 days ago
  • $52 - $56 per hour

     ...Type: Contract Location: 100% remote within the U.S. Schedule:...  ...Investigate and manage clinical grievances, appeals, and external reviews from intake to resolution. Review medical necessity, quality-of-care...  .... Collaborate with Medical Directors and prepare clear, compliant... 
    Remote work
    Medical
    Contract work
    Afternoon shift

    Phaxis

    New York, NY
    4 days ago
  •  ...Appeals & Grievances Case Manager (Oregon) Immediate need for a talented Appeals & Grievances Case...  ...-term potential and is located in US (Remote). Please review the job description below...  ...skills ~ Experience reviewing medical records and clinical documentation... 
    Remote work
    Medical
    Contract work
    Immediate start

    Pyramid Consulting

    Portland, OR
    6 hours ago
  • $83.1k - $118.56k

     ...Conditions, Prior Approval, Medical Necessity, Pre-certification,...  ...Prepare cases for Medical Director Review ensuring that all pertinent...  ..., Fair Hearing, and External Appeal through all levels of the...  ...with experience in appeals & grievances, claims processing, utilization... 
    Remote work
    Medical
    Contract work
    Temporary work
    Work experience placement
    Local area

    Health First

    United States
    4 days ago
  • $27.02 - $48.55 per hour

     ...Position Purpose: Facilitate medical necessity grievance, appeals and denials including disposition of denials...  ...RN Licensure. This position is remote and will work PST hours. Review clinical...  ...and submitting cases to the Medical Director for review Recognize and identify potential... 
    Remote work
    Medical
    Hourly pay
    Full time
    Part time
    Work at office
    Flexible hours

    Centene Management Company LLC

    Sacramento, CA
    5 hours ago
  •  ...Duties Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and...  ...appropriate appeals and grievance outcomes. Requests and reviews medical records, notes, and/or detailed bills as appropriate;... 
    Remote job
    Medical
    Contract work
    Work at office

    Molina Healthcare, Inc.

    Salem, OR
    1 day ago
  • $48.32k - $82.39k

     ...verbal and written claims and authorization grievance/appeals from providers and members. Resolve all...  ...Centene Pharmacy Services is hiring a remote Grievance & Appeals Coordinator II. The...  ...on determination level or prepare for medical review presentation. ~ Prepare... 
    Remote work
    Medical
    Hourly pay
    Full time
    Part time
    Work at office
    Flexible hours

    Centene Corporation

    Florida
    3 days ago
  • $41.89k - $60.65k

     ...primary care, care for the most medically and socially complex...  ...for Part C and D Pre-Service Appeals . Note: This position schedule...  ...years of related experience in Grievances and Appeals. ~ High school...  ...GAD Coordinator Work Mode: Remote Schedule: This position... 
    Remote work
    Medical
    Hourly pay
    Full time
    For contractors
    Work at office
    Monday to Friday

    SCAN Health Insurance

    Remote
    4 days ago
  • $60.78k

     ...Appeals and Grievances Specialist IIJob Category: Customer Service Department: Appeals & Grievances...  ...Managed Health Care (DMHC), Managed Risk Medical Insurance Board (MBMIB) and National...  ..., on weekends, holidays, a hybrid remote schedule, occasional flexibility in hours... 
    Remote work
    Medical
    Full time
    Local area
    Shift work
    Weekend work

    LOS Angeles Care Health Plan

    Los Angeles, CA
    4 days ago
  • $40k - $52.3k

    Grievances & Appeals Representative The Grievances & Appeals Representative 2 manages client denials...  ...in the healthcare industry or medical field Must have experience in a production...  ...HIPAA information. Travel: While this is a remote position, occasional travel to Humana's... 
    Remote work
    Medical
    Temporary work
    Work at office
    Work from home
    Home office
    Monday to Friday
    Shift work

    Humana

    New York, NY
    2 days ago

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to Remote Medical Appeals & Grievances Director. Be the first to apply!