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

Remote RN: Grievances & Appeals Specialist

Phaxis

New York, NY
  • 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

Vacancy posted 1 day ago
Similar jobs that could be interesting for youBased on the Remote RN: Grievances & Appeals Specialist in New York, NY vacancy
  • 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

    Health First

    United States
    2 days ago
  • 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

    Centene

    Sacramento, CA
    3 days ago
  •  ...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

    Acentra Health, LLC

    Salem, OR
    2 days ago
  •  ...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

    Network Health

    Menasha, WI
    4 days ago
  • $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 work
    Full time
    Contract work
    Work at office

    Molina Healthcare

    Remote
    17 days ago
  • $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 work
    Full time
    Local area
    Shift work
    Weekend work

    LOS Angeles Care Health Plan

    Los Angeles, CA
    1 day ago
  • $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 work
    Full time
    Contract work
    Work at office
    Weekend work

    Molina Healthcare

    Remote
    2 days ago
  •  ...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 job
    Contract work
    Afternoon shift

    Phaxis

    New York, NY
    3 days ago
  • 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.

    New York, NY
    2 days ago
  • 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 job
    Flexible hours

    Centene Corp.

    Topeka, KS
    1 day ago
  • 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

    Harbor Health

    Austin, TX
    2 days ago
  • 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

    Banner Health

    Salem, OR
    4 days ago
  • 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 job
    Monday to Friday
    Shift work

    Humana

    Phoenix, AZ
    3 days ago
  • 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 job
    Monday to Friday
    Shift work

    Humana

    Austin, TX
    4 days ago
  • $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 work
    Hourly pay
    Full time
    Contract work
    Work experience placement
    Work at office

    Molina Healthcare, Inc.

    Phoenix, AZ
    3 days ago
  • 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 work
    Home office

    HARBOR HEALTH

    Austin, TX
    2 days ago
  • 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

    Healthedge

    New York, NY
    2 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 2+ years of clinical nursing experience, with NCQA and InterQual knowledge preferred. You will review cases... 
    Remote job
    Flexible hours

    Centene Corp.

    New York, NY
    2 days ago
  • $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 job
    Long term contract
    Monday to Friday

    Phaxis - Healthcare

    Huntington, NY
    2 days 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 and PST hours. You will review clinical data, prepare case reviews for the... 
    Remote job

    Centene Corp.

    Sacramento, CA
    3 days 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/LVN license and PST hours for remote work. You will review clinical data, overturn or uphold denials per... 
    Remote job

    Centene Corp.

    Sacramento, CA
    3 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 York State and hold an active NY RN license. The schedule is Monday-Friday, 9 AM-5 PM, with compensation at $5... 
    Remote job
    Long term contract
    Contract work
    Monday to Friday

    Phaxis - Healthcare

    Huntington, NY
    2 days ago
  •  ...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 work
    Full time
    Contract work
    Work at office

    Community Health Systems Professional Services Corporation

    Remote
    5 days ago
  • 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 job
    Contract work
    Temporary work
    Weekend work

    Wellframe

    New York, NY
    3 days ago
  •  ...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

    Centene Corp.

    Sacramento, CA
    3 days ago
  • $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 work
    Contract work
    Afternoon shift

    Phaxis

    Manhattan, IL
    24 days ago
  • $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

    WPS—A health solutions company

    New York, NY
    5 days ago
  • $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 job
    Full time
    Monday to Friday
    Shift work

    Healthfirst

    New York, NY
    3 days ago
  • $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 work
    Hourly pay
    Full time
    Part time
    Work at office
    Flexible hours

    Centene Corporation

    New York, NY
    1 day ago
  • 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

    Healthfirst

    New York, NY
    3 days ago

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to Remote RN: Grievances & Appeals Specialist. Be the first to apply!