Remote RN: Grievances & Appeals Specialist
Phaxis
- Remote job
Phaxis is hiring a licensed RN for a fully remote Grievances & Appeals contract opportunity with a leading healthcare organization across the United States. The role offers $55/hour, weekly pay, 9 AM–5 PM EST coverage, and equipment provided. You will review grievances, appeals, and medical necessity denials, collaborate with Medical Directors, ensure regulatory compliance, and drive timely case resolutions with strong documentation and communication. #J-18808-Ljbffr Phaxis
- 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
- Centene is seeking a California-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 determine if criteria are met under NCQA guidelines...Remote job
- ...Acentra Health is seeking an Appeals and Grievance Specialist to join our growing team. You will conduct thorough research and investigations to resolve... ..., and ensure prompt completion of the process. This is remote with core hours in the Eastern Time Zone. Required: high...Remote work
- ...Network Health is seeking an Appeals and Grievance Specialist I to join our Wisconsin team. The role reviews member appeals, investigates findings... ...strong communication and regulatory interpretation skills. Remote 1.0 FTE, with occasional travel to offices in Menasha or...Remote work
$30.7k - $66.5k
...Medicare and Medicaid Services (CMS). Essential Job Duties • Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and related outside agencies to ensure that internal and/or regulatory...Remote workFull timeContract workWork at office$60.78k
...Appeals and Grievances Specialist IIJob Category: Customer Service Department: Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position Type... ...work after hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in hours/shift in critical...Remote workFull timeLocal areaShift workWeekend work$30.7k - $66.5k
...Medicare and Medicaid Services (CMS). Essential Job Duties • Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and related outside agencies to ensure that internal and/or...Remote workFull timeContract workWork at officeWeekend work- ...York health plan. You will own clinical grievances and appeals from intake to final decision letters,... ...InterQual/MCG criteria. The position is 100% remote in the United States, with business... ...deadlines. Requires active NY RN license and payer-side experience. #J-...Remote jobContract workAfternoon shift
- Centene Corp. is seeking a remote Grievance & Appeals Coordinator II for Centene Pharmacy Services. You will analyze and resolve member and provider grievances and appeals, coordinating with internal teams and health plan partners, while ensuring regulatory compliance....Remote job
- Centene Corp. is seeking a Grievance & Appeals Coordinator I for a remote KS role. You will analyze and resolve member and provider grievances and appeals, prepare formal responses, and maintain detailed case files in a fast-paced environment. The role requires a high...Remote jobFlexible hours
- Harbor Health in Texas seeks an Appeals & Grievances Specialist to investigate, process, and resolve member and provider complaints, grievances, and appeals. This fully remote role focuses on Texas IFP/Marketplace and large-group products, ensuring timely investigations...Remote job
- Banner Health is seeking a Health Plans Grievance and Appeals Coordinator in a remote role. You will manage grievances, appeals, and disputes for members and providers, ensuring timely investigations and communications. The role requires knowledge of AHCCCS, HCG, CMS rules...Remote job
- Humana, Inc. is seeking a Grievances & Appeals Representative 2 to manage client denials and concerns by conducting analytic reviews of clinical... ...determinations in a production-driven environment. This remote role supports members and providers, applying Humana policies...Remote jobMonday to FridayShift work
- Humana, Inc. is seeking a Grievances & Appeals Representative to manage member and provider inquiries, investigate concerns, and deliver timely... ...application, and collaboration across teams in a primarily remote setting. The position requires prior customer service...Remote jobMonday to FridayShift work
$21.16 - $38.37 per hour
Join to apply for the Medicare Appeals & Grievances Specialist (PST Hours) role at Molina Healthcare . This position is remote and will be working Pacific Standard hours. Highly Qualified Candidates Will Have The Following Experience Strong understanding of UM, Appeals...Remote workHourly payFull timeContract workWork experience placementWork at office- Job Category Appeals, Grievances, Specialist Employee Type Exempt - FT Manage Others No Contact information Phone (***) ***-**** Email ****@*****.***... ...provider complaints, grievances, and appeals. This fully remote position focuses primarily on supporting our Texas fully...Remote workHome office
- HealthEdge is seeking a remote (US) Appeals & Grievances Specialist to independently process complex grievances and conduct medical necessity reviews across inpatient, outpatient, and ancillary services. You will prepare documentation for regulatory standards and coordinate...Remote job
- 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 2+ years of clinical nursing experience, with NCQA and InterQual knowledge preferred. You will review cases...Remote jobFlexible hours
$53 per hour
REMOTE RN OPPORTUNITY - GRIEVANCE & APPEALS / UTILIZATION REVIEW We're hiring experienced Registered Nurses to join a leading healthcare organization in a fully remote role! Position Details Location: Remote - Must reside in New York State Schedule: Monday-Friday | 9 AM...Remote jobLong term contractMonday to Friday- 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 and PST hours. You will review clinical data, prepare case reviews for the...Remote job
- 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/LVN license and PST hours for remote work. You will review clinical data, overturn or uphold denials per...Remote job
$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 York State and hold an active NY RN license. The schedule is Monday-Friday, 9 AM-5 PM, with compensation at $5...Remote jobLong term contractContract workMonday to Friday- ...expertise and dedication. Paid Time Off Job Summary The Appeal Specialist II reviews, analyzes, and resolves insurance denials to ensure... ...software and Google Suite. Licenses and Certifications RN - Registered Nurse - State Licensure and/or Compact State...Remote workFull timeContract workWork at office
- HealthEdge is seeking a Temporary A&G RN to independently process... ...SLA targets. You will investigate grievances, perform medical necessity reviews... ...settings, and prepare documentation for appeals in line with NCQA standards. Remote work from the US is supported, with...Remote jobContract workTemporary workWeekend work
- ...LLC is seeking a nurse to facilitate medical necessity grievances, appeals and denials while reviewing clinical data to determine if criteria are met. The role requires California RN/LPN licensing and supports remote work with PST hours. Responsibilities include...Remote job
$52 - $56 per hour
...RN Grievance & Appeals Specialist Remote Contract RNs with direct payer-side Grievance & Appeals experience this opportunity is for you. Were seeking an RN who has personally managed clinical grievances and appeals from investigation through the final determination...Remote workContract workAfternoon shift$66k - $68k
WPS, a health solutions company, seeks an Appeals Nurse to review first-level appeal cases, assess medical necessity, and prepare rationale... ...and communication skills are essential. The role offers remote work options across approved states, with a base salary in the...Remote job$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...Remote jobFull timeMonday to FridayShift work$27.02 - $48.55 per hour
...Position Purpose Facilitate medical necessity grievance, appeals and denials including disposition of denials notification letters... ...are met Key Details Candidate must hold California RN Licensure. This position is remote and will work PST hours. Responsibilities Review...Remote workHourly payFull timePart timeWork at officeFlexible hours- 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...Remote work
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