Grievance & Appeals QA Leader (Remote)
NACBA
- Remote job
CVS Health is seeking a Senior Manager of Quality Assurance and Audit to lead the QA strategy for Grievance & Appeals, ensuring regulatory readiness across Medicare, Medicaid and Duals. You will manage a remote team of Quality Analysts, drive continuous improvement, and maintain audit readiness with cross-functional partners. The role requires strong leadership, expertise in QA and audits, and the ability to influence policy and system enhancements in a highly regulated environment. #J-18808-Ljbffr NACBA
- ...States seeks a Senior Manager, Quality Assurance and Audit to drive QA program strategy across Medicare, Medicaid, and Duals, ensuring regulatory compliance and audit readiness. You will lead a remote team of Quality Analysts and partner cross-functionally to drive continuous...Remote job
- ...is seeking a Senior Manager, Quality Assurance and Audit to lead QA strategy across Medicare, Medicaid, and Duals, ensuring regulatory... ...with cross-functional partners. This full-time role emphasizes remote team leadership, strong training and coaching, and effectiveness...Remote jobFull time
- ...Health is seeking a Senior Manager of Quality Assurance and Audit to lead strategic QA programs for Grievance & Appeals across Medicare, Medicaid, and Duals. The role directs a remote team of Quality Analysts, drives regulatory readiness, and partners cross-functionally...Remote work
- Centene Corp. is seeking a clinical professional to support the Illinois Medicaid grievance and appeals processing team in a remote capacity. The role follows a 8:00 AM-5:00 PM Central Time schedule with on-call duties on some weekends, ensuring timely case processing....Remote jobWeekend work
- ...Manager, Quality Assurance and Audit to lead the Grievance & Appeals QA program across Medicare, Medicaid, and Duals... ...environment. You will build and mentor a remote team of Quality Analysts, partner with cross‑functional leaders, and deliver continuous improvements in...Remote job
- Sentara Health Plans in Virginia Beach region seeks a Director of Appeals and Grievance to plan, develop, and direct the department across Commercial, Medicaid, and Medicare lines of business. This role leads program development, strategic planning, and operational execution...Remote job
- ...Grievance & Appeals CoordinatorAre you an analytical problem solver with a passion for healthcare managed care? We are seeking dedicated Grievance... ...to join our growing, collaborative team! In this fully remote role, you will analyze and resolve complex member and...Remote workWork from homeHome officeWeekend work
$67.9k - $182.55k
...execution of quality programs within the Grievance & Appeals QA organization. This role ensures... ..., policies, and audit processes. This leader partners cross-functionally to drive continuous... ...a team of Quality Analysts in a remote environment Track, monitor, and manage...Remote workHourly payFull timeTemporary workWork at officeLocal area- ...is seeking a Senior Manager, Quality Assurance and Audit to lead QA programs across Medicare, Medicaid, and Duals, ensuring regulatory... ...-functional collaboration. The position emphasizes leadership of remote teams, continuous improvement, and strategic oversight of audit...Remote job
- CVS Health is seeking a Senior Manager, Quality Assurance and Audit to lead the strategic QA program across Medicare, Medicaid, and Duals. You will guide a remote team of Quality Analysts, ensuring audit readiness, compliance, and continuous process improvement in a highly...Remote job
- 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
- ...seeking a Senior Manager, Quality Assurance and Audit to lead the G&A QA program across Medicare, Medicaid, and Duals. You will set... ...ensure compliance in a highly regulated environment while guiding a remote team of quality analysts. You will oversee internal and external...Remote job
- ...States seeks a Senior Manager, Quality Assurance and Audit to lead QA programs across Medicare, Medicaid, and Duals. You will drive... ...develop a high-performing team of Quality Analysts in a largely remote environment. This role requires strategic thinking, cross-functional...Remote work
$248.5k - $373k
.... Growing together.Work at home!You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities:The Appeals and Grievances Medical Director is responsible for ongoing clinical review and adjudication...Remote workMinimum wageWork experience placementLocal areaWork from home- 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...Remote work
$60.78k
...Appeals and Grievances Specialist II Job Category: Customer Service Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition... ...requires work after hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in hours/shift in critical...Remote workFull timeLocal areaShift workWeekend work- ...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
- ...UnitedHealthcare is hiring a Medical Director for Appeals and Grievances, responsible for clinical review and adjudication across multiple health plans. The role supports remote work from anywhere in the U.S. and requires collaboration with regional and plan medical directors...Remote job
- ...L.A. Care Health Plan is seeking an Appeals and Grievances Specialist II in Los Angeles, CA. The role involves investigating member and provider complaints, ensuring compliance with various health regulations, and preparing reports. Requirements include at least 2 years...Remote workFull time
- ...Appeals And Grievances Lead 3 Key Consulting is recruiting an Appeals and Grievances Lead for a consulting engagement with our direct client... ...all levels including but not limited to members, peers, leaders, physicians, executives, and regulatory entities. Strong...Flexible hoursWeekend work
$23.22 - $34.84 per hour
A leading health insurance provider is seeking a Grievance & Appeals Coordinator to work virtually full-time, with responsibilities including summarizing complaints, ensuring resolution of grievances, and documenting interactions. The ideal candidate should possess a high...Remote workHourly payFull time- A staffing solutions company is seeking a Grievance & Appeals Coordinator for a fully remote position in Detroit, MI. This role involves processing appeals, grievances, and inquiries while maintaining accurate documentation and effective communication. The ideal candidate...Remote jobContract work
$30 - $35 per hour
...Mid-Senior Level professional for a contract role to manage grievances and appeals. Candidates should have 6+ years in customer service with strong... ...pay range of $30.00/hr - $35.00/hr based on qualifications. Remote work is available for candidates within 100 miles of...Remote jobContract workFor contractors- ...seeking a clinical professional to join our Medical Management/Health Services team to ensure proper processing of member grievances, provider appeals, and state fair hearings. You will serve as the primary contact with the State and oversee the daily activities of the...Remote job
- ...Job Title: Grievance & Appeals Coordinator I Location: Remote in Indiana (**MUST be a resident of Indiana) Pay: $22 hourly - *weekly pay Position Purpose: Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal...Remote workHourly payWeekly pay
$27 - $31 per hour
Pyramid Consulting, Inc. is seeking an Appeals & Grievances Case Manager for a California assignment in Los Angeles. This is a 06+ months contract with potential for extension, and is listed as remote in the LA area. The role requires extensive appeals experience within...Remote jobHourly payContract work- Firstsource Healthcare is seeking a detail-oriented Claims & Appeals & Grievances (A&G) Specialist to join our Healthcare Operations team. The candidate should have at least two years of experience in US healthcare back-office operations with expertise in claims processing...Remote job
$40k - $52.3k
...Grievances & Appeals Representative Become a part of our caring community and help manage client denials and concerns by conducting a comprehensive... ...member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to Humana's offices for training...Remote workTemporary workWork at officeWork from homeHome officeMonday to FridayShift work- ...Job Title Job Description Process appeals and grievances, analyze, research, and provide comprehensive responses in accordance with established... ...applying contract and regulatory provisions. This is a Remote Role Experience Experience handling a large load of...Remote workContract workApprenticeshipLocal area
- Maximus, Inc. is seeking a Manager - Appeals to oversee day-to-day operations of the Appeals department in a remote setting, ensuring compliance, quality and a high-quality customer experience. The role leads teams, develops quality controls, and drives process improvements...Remote job
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