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$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 workMedicalFull timeWork from homeHome office$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 workFull timePart timeWork at officeFlexible hours- ...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 workMedicalFull time
- ...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 workMedical
- 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 jobMedical
- 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 jobMedicalFlexible hours
- ...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 jobMedical
- ...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 jobMedical
- 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 jobMedical
- 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 jobMedical
$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 jobMedicalLong term contractMonday to Friday$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 workMedicalFull timeWork at office- 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 jobMedicalContract work
- ...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 jobMedical
$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 - HealthcareRemote jobMedicalLong term contractContract workMonday to Friday- 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 jobMedicalContract work
- ...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 jobMedicalContract workTemporary workWeekend work
- 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 jobMedical
$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 workMedicalFull timeContract workWork at office$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 jobMedicalContract workImmediate start$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 workMedicalFull timeTemporary workApprenticeshipWork at officeWork from homeHome officeMonday to FridayWeekend work$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 workMedicalContract workAfternoon shift- ...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 workMedicalContract workImmediate start
$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 workMedicalContract workTemporary workWork experience placementLocal area$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 workMedicalHourly payFull timePart timeWork at officeFlexible hours- ...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 jobMedicalContract workWork at office
$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 workMedicalHourly payFull timePart timeWork at officeFlexible hours$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 workMedicalHourly payFull timeFor contractorsWork at officeMonday to Friday$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 workMedicalFull timeLocal areaShift workWeekend work$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 workMedicalTemporary workWork at officeWork from homeHome officeMonday to FridayShift work
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