Clinical Appeals & Grievances Expert (RN)
Healthfirst
Healthfirst is seeking an A&G Clinical Specialist to lead the development and resolution of clinical cases for member and provider appeals, ensuring compliance with applicable laws and internal policies. The role can be remote or on-site at the NYC or Lake Mary locations, with travel as needed. You will manage your own caseload, perform issue research, interpret guidelines, and prepare cases for internal and external reviews. #J-18808-Ljbffr Healthfirst
Vacancy posted 1 day ago
Similar jobs that could be interesting for youBased on the Clinical Appeals & Grievances Expert (RN) in New York, NY vacancy
$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...SuggestedRemote jobFull timeMonday to FridayShift work- WPS Health Solutions is hiring an Appeals Nurse to review medical records and claims for first-level Medicare appeal... ...medically reviewed. Qualifications include an active RN license (state of practice), 1+ years clinical experience, and strong communication skills. #J-1880...SuggestedRemote job
- 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...SuggestedRemote work
Healthfirst
New York, NY16 hours ago - ...and Case Management leaders — including RN UM directors, case management managers, and... ...to evaluate AI tools designed to enhance clinical review, medical-necessity determination,... ...peer-to-peer review requests, and denial appeals. Coordinate with clinical teams, payers,...SuggestedNight shift
- ...Barbara Cottage Hospital is seeking a PRN Clinical Review Specialist to provide remote... ...outpatient services. The role requires an active RN license (compact preferred), 3-5 years of... ..., and 2+ years in Utilization Review/Appeals. Strong documentation and Epic EMR skills...SuggestedRemote jobRelief
$100k - $150k
...platform for infinitely scalable clinical capacity. We radically... ...combining AI agents with clinical experts to take on high-impact clinical... ...Review prior authorizations, appeals, and other clinical‑administrative... ...clinical licensure : Current RN, NP, or equivalent clinical...Remote work$150 per hour
...authorisation workflows for medical and clinical services across multiple payer types.... ...Track authorisation status, denials, and appeal outcomes to identify workflow improvement... .... Preferred Clinical licensure ( RN , LPN , or equivalent) or relevant certification...Contract workSummer workWork at officeRemote workMercor
New York, NYa month ago- Healthfirst in New York is seeking a Clinical Auditor to perform audit functions for clinical teams and partners, focusing on operational... ...regulatory compliance. The ideal candidate will have a NYS LPN or RN license, strong clinical judgment, and relevant experience in...
- Mount Sinai Hospital is seeking a Clinical Nurse to provide safe, patient-centered care in a Medical-Surgical/Telemetry setting. The role emphasizes evidence-based practice, adherence to the nursing process, and collaboration with the healthcare team to ensure optimal...
- Mount Sinai Health System is seeking a Clinical Nurse in New York City to deliver safe, patient-centered care within a supportive team. The role emphasizes the nursing process, relationship-centered care, and collaboration with interdisciplinary colleagues to develop and...
$64.85 per hour
Mount Sinai Medical Center in New York seeks a Clinical Nurse responsible for providing high-quality care for patients while collaborating... ...teams. Qualifications include an accredited nursing degree and RN licensure in New York State. The role emphasizes patient-centered...Hourly pay- Centene is seeking a Clinical Review Nurse to perform concurrent reviews of members to determine overall health, evaluate medical necessity, and contribute to discharge planning. This role targets nurses with acute care experience and a strong understanding of utilization...Remote jobFull time
- SME Careers is seeking a General Nurse Subject Matter Expert for a remote contractor role to review and create healthcare content. Your expertise will enhance AI models' accuracy in clinical reasoning. Applicants should have 3-5 years of nursing experience and active licensure...Remote jobFor contractors
- ...care for adult and pediatric research participants in a diverse clinical trial setting. The role partners with the research team to direct... ...with minimal supervision. The ideal candidate holds a NYS RN license, has 3+ years in clinical nursing, and can navigate protocol...Daily paid
$55 - $65 per hour
.... Position: Adult Inpatient Nurses (RN) Type: Contract Compensation: $... ...Responsibilities Review and evaluate AI-generated clinical outputs based on nursing flowsheet... ...for AI training datasets . Provide expert feedback on nursing assessments and...Contract workSummer workRemote workMercor
New York, NY11 days ago$110 per hour
Physician - Clinical Advisor (Women's Health Expert) Employment Type: 0.5 FTE (20 hours/week) Compensation: $110/hour (W2) Schedule: Monday-Friday 5:00 a.m.-5:00 p.m. PT Reports To: Christy Beyer, MD, Medical Director Midi Health is the leading virtual clinic dedicated...Immediate startMonday to Friday- ...help train and evaluate AI systems used in clinical and healthcare settings. This role is... ...assessment data for AI training datasets Provide expert feedback on nursing assessments and... ...benchmarks Basic Qualifications Active RN license (U.S., outside California)...
$84 per hour
...D'Angelo , Larry Summers , and Jack Dorsey . Position: Clinical Documentation Integrity (CDI) Leader Type: Contract Compensation... ...risk adjustment and outpatient CDI programs. Background in RN , RHIA , CCS , or similar clinical or coding credential....Remote jobContract workSummer workMercor
New York, NY3 days ago$130 - $180 per hour
...Larry Summers , and Jack Dorsey . Position: Psychiatry Expert Type: Contract Compensation: $130–$180/hour Location... ...: 20+ hours/week Role Responsibilities Design clinically realistic prompts and scenarios from your Psychiatry practice...Weekly payContract workSummer workWork at officeRemote workMercor
New York, NYa month ago$180 per hour
...Larry Summers , and Jack Dorsey . Position: Cardiology Expert Type: Contract Compensation: $180–$400/hour Location... ...: 20+ hours/week Role Responsibilities Design clinically realistic prompts and scenarios from your Cardiology practice...Weekly payContract workSummer workWork at officeRemote workMercor
New York, NYa month ago$150 per hour
...Role Responsibilities Create and critique rubrics that analyze commercial drugs and drug-development programs. Interpret clinical trial endpoints and judge whether results would change prescribing. Assess implications for real-world uptake in your therapeutic...Hourly payContract workFor contractorsSummer workRemote workMercor
New York, NY13 days ago- ...and detail-oriented Utilization Management Registered Nurse (UM RN) to join our remote healthcare team. In this role, you will conduct... ...Advantage regulations. The ideal candidate will have strong clinical judgment, a valid RN license, and 3+ years of experience in utilization...Remote job
- ...healthcare team in White Plains, NY. This role requires managing high-risk obstetric cases, performing surgical duties, and maintaining clinical documentation. The ideal candidate has at least 2 years of experience, a BSN, and is adept in a fast-paced environment. The role...
- Dandy is transforming the dental industry by delivering a digital platform and clinical support to dental offices worldwide. We are hiring a Clinical Support Expert who specializes in aligners to join our Customer Experience Team and provide high-level clinical guidance...Worldwide
- The RN Oncology Infusion Therapy Clinician functions under the direction of the Manager Infusion Therapy or other designated leader... ...Infusion Therapy Clinician demonstrates knowledge, competency, and clinical expertise in oncology infusion therapy including but not limited...
- ...Registered Nurse to provide care during diagnostic and interventional procedures. This role requires a current RN license in New Jersey and prior experience in a clinical setting. Key responsibilities include patient assessment, documentation, and assisting physicians with...
$175k - $250k
...conditions a spreadsheet can’t predict. As our subject matter expert for this domain, you will bring that judgment into the product... ...systems, you will: Develop and deliver subject matter expertise in clinical operations and patient flow to support AI product development...Full timeWork at office- Dandy is hiring a Clinical Support Expert who specializes in RPD, dentures and Sleep Apnea devices. You will join the Customer Experience Team to provide top-tier clinical expertise and outstanding support to dental professionals, serving as a high-level authority for complex...Full time
- A consulting organization in health care is seeking Board Certified Urologists for a short-term engagement as Clinical Expert Consultants. This remote position involves participating in virtual interviews to provide insights on treatment options related to neurogenic conditions...Remote jobTemporary workFlexible hours
- ...innovation, and world-class support to achieve more for their practices, their people, and their patients. Dandy is hiring a Clinical Support Expert who specializes in RPD, Dentures and Sleep Apnea devices to join our rapidly growing, venture-backed company. As a critical...Full timeLocal areaMonday to FridayShift work
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Clinical Appeals & Grievances Expert (RN). Be the first to apply!
Related searches
- technology expert New York, NY
- subject matter expert New York, NY
- fulfillment expert New York, NY
- guest service support expert New York, NY
- sql expert New York, NY
- wound rn New York, NY
- entry level registered nurse New York, NY
- psych rn New York, NY
- non clinical rn New York, NY
- clinic registered nurse rn New York, NY