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

Remote Appeals & Grievances Specialist (RN/LPN/DH)

Health First

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 issues, and ensuring compliance with regulations. Ideal candidates should have experience in clinical practice and knowledge of Utilization Review Guidelines. The position offers a competitive salary and an opportunity to work with a dynamic team. #J-18808-Ljbffr

Vacancy posted 4 days ago
Similar jobs that could be interesting for youBased on the Remote Appeals & Grievances Specialist (RN/LPN/DH) 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
    4 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
    5 days ago
  •  ...Point32Health, Inc. is seeking an Appeals and Grievance Coordinator to manage day-to-day tasks within the A&G department. You will process mail, assign cases, and support analysts while ensuring compliance with regulatory timelines. The role requires 1-2 years of relevant... 
    Remote work
    Work from home

    Point32Health, Inc.

    United States
    4 days ago
  •  ...Healthfirst seeks a Grievance Specialist to join the Appeals & Grievances team. This is a 100% remote, non-clinical role focused on resolving member grievances across Medicare, Medicaid, CHPlus, SHP, QHP, EP, and CompleteCare. The Specialist will independently manage... 
    Remote work

    Health First

    United States
    3 days ago
  •  ...Managing the full life cycle of member and provider appeals and grievance cases, the full-time Appeals and Grievance Specialist will conduct case intake, investigation, and...  ...to ensure timely resolution while working remotely. Key responsibilities Research and analyze case... 
    Remote work
    Full time
    Work at office

    Virtual Vocations Inc

    United States
    3 days ago
  •  ...to work independently and manage multiple priorities in a remote setting.\n- Understands state and federal requirements\n-...  ...Job Description An employer is looking for a remote Appeals & Grievances Specialist who will be responsible for managing and resolving appeals... 
    Remote work
    Work at office

    Insight Global

    United States
    5 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

    Phoenix, AZ
    2 days ago
  • $60.78k

     ...net required to achieve that purpose. Job Summary The Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member and provider...  ...work after hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in hours/shift in critical... 
    Remote work
    Local area
    Shift work
    Weekend work

    L.A. Care Health Plan

    Los Angeles, CA
    1 day ago
  • $45.9k - $78.6k

     ...is the norm and every member feels valued. The Appeals & Grievances Specialist III role manages and resolves member complaints, grievances...  ...time between 7 AM - 9 AM CT This position is a Remote role. To be eligible for consideration, candidates must have... 
    Remote work
    Work experience placement

    Medica

    United States
    4 days ago
  • A-Line Staffing Solutions in Georgia is seeking a Grievance & Appeals Coordinator I to manage the grievance and appeals workflow in a regulated...  ..., accurate outcomes. This hybrid role offers office and remote work, standard business hours, and benefits after 90 days with... 
    Remote job
    Work at office

    A-Line Staffing Solutions

    New York, NY
    1 day ago
  • Humana is seeking a Grievances and Appeals Representative 4 within the Internal Review Team to manage denials by reviewing clinical documentation...  ...outcomes, while maintaining high productivity and strict confidentiality in a remote work setup. #J-18808-Ljbffr Humana
    Remote job

    Humana

    San Juan, TX
    4 days ago
  • Medica, a nonprofit health plan serving communities across multiple states, seeks a remote Appeals & Grievances Specialist III to manage complex member complaints, grievances, and appeals with regulatory alignment. You will work with cross-functional teams to ensure timely... 
    Remote job

    Medica

    Minnetonka, MN
    2 days ago
  • $59 - $60 per hour

    WE’RE HIRING: REMOTE REGISTERED NURSE (RN) 100% REMOTE | MONDAY-FRIDAY | $59-$60/HR We are looking for experienced Registered Nurses for a...  ...Utilization Management experience Prior Authorization experience Grievance & Appeals experience preferred, but not required #J-18808-Ljbffr... 
    Remote work
    Monday to Friday

    Phaxis

    New York, NY
    1 day ago
  • Panacea Health is seeking a Centralized Intake Specialist for Saturdays and Sundays, 8am-8pm, with remote work available to residents of Pennsylvania. You will...  ...and initiate intake with care. The role requires RN or LPN licensure in PA, experience with admission coordination... 
    Remote job
    Weekend work

    Panacea Health

    New York, NY
    3 days ago
  •  ...Health Corp is seeking a dynamic Centralized Intake Specialist to join our healthcare team. This remote, part-time role requires living in Pennsylvania and...  ...care and accuracy. Ideal candidates have an active PA RN or LPN license, strong communication skills, and experience... 
    Remote job
    Part time
    Weekend work

    Panacea Health Corp

    New York, NY
    2 days ago
  • $26.99 per hour

    We are currently seeking experienced Appeals & Grievances Specialists!  This is a full remote opportunity paying $27/hr.  The ideal candidate has experience investigating and responding in writing to internal and regulatory complaints.  Experience in ACA is a plus.  If... 
    Remote work
    Hourly pay
    Permanent employment
    Temporary work
    Work experience placement
    Shift work
    New York, NY
    12 days ago
  • Ampcus Inc. is seeking a Utilization Management Specialist (Remote) to review medical necessity and authorization for clinical services. The role emphasizes clinical nursing expertise, care management experience, and adherence to guidelines and policies. The position requires... 
    Remote job

    Ampcus Inc

    Owings Mills, MD
    4 days ago
  •  ...Member Appeals Specialist Primary responsibilities would include triaging incoming appeals/grievances, categorizing them appropriately, assigning them to the team, making outbound calls when necessary. Also checking voicemails, responding to emails/voicemails. The... 
    Remote work
    Traineeship

    Saviance

    United States
    3 days ago
  • $21.16 - $38.37 per hour

    A healthcare provider is seeking a Medicare Appeals & Grievances Specialist to handle member appeals and grievances. This remote position requires strong experience in managed care, particularly with Medicare regulations. Ideal candidates will have excellent attention... 
    Remote job
    Hourly pay
    Work at office

    Molina Healthcare

    Phoenix, AZ
    4 days ago
  • $55 - $60 per hour

     ...Phaxis is looking for a dedicated Remote RN Grievance and Appeals Specialist in Manhattan where your contributions will make a meaningful impact on patient care and overall clinic operations. We are looking for a reliable and detail-oriented individual who thrives in... 
    Remote work
    Hourly pay
    Permanent employment
    Contract work
    Temporary work
    Monday to Friday

    Phaxis

    Manhattan, IL
    12 days ago
  •  ...Weekend Nurse (RN or LPN)Looking for qualified Weekend Nurse (RN or LPN) to join our team...  ...concerns from residents and families, ensuring grievances are handled professionally and...  ...adults. From telemedicine services and remote health monitoring to advanced diagnostic... 
    Remote work
    Full time
    Local area
    Shift work
    Night shift
    Weekend work
    Day shift
    Afternoon shift

    Avardis Health

    Arden, NC
    1 day ago
  • $22 - $25 per hour

     ...communities."  Western Health Advantage Western Health Advantage (WHA) is seeking a detail-oriented and customer-focused Appeals & Grievances Specialist to join our team. In this fast-paced role, you will support members by managing appeals and grievances while ensuring... 
    Hourly pay
    Work experience placement

    Western Health Advantage

    Sacramento, CA
    3 days ago
  • $66.3k - $79.8k

     ...Overview Resolves grievances, appeals and external reviews for VNS Health Plans product lines - Managed Long Term Care (MLTC), Medicare Advantage (MA), Fully Integrated Dual Advantage (FIDA) and Select Health. Ensures regulatory compliance, timeliness requirements and... 
    Work experience placement
    Work at office
    Flexible hours

    VNS Health

    New York, NY
    3 days ago
  •  ...Job Description Job Description Appeals Specialist (LPN, RN, or Therapist) Location: Massachusetts (RegalCare Facility network / Hybrid-Remote options available) Position Type: Full-Time Role Overview RegalCare is seeking a detail-driven Appeals Specialist... 
    Remote work
    Full time

    RegalCare

    Holyoke, MA
    10 days 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
    4 days ago
  •  ...Looking for qualified Unit Manager (RN or LPN) to join our team! Location: Willowbrook...  ...Work with families and staff to address grievances and maintain resident rights. Assist...  ...adults. From telemedicine services and remote health monitoring to advanced diagnostic... 
    Remote work
    Full time
    Local area
    Shift work
    Night shift
    Day shift
    Afternoon shift

    Avardis Health

    Yadkinville, NC
    4 days ago
  • A national recruiting company is seeking a Grievance/Appeals Representative in Thousand Oaks, CA. The role involves reviewing claims, investigating customer grievances, and ensuring resolution of appeals. Candidates must possess a high school diploma and have 1 to 3 years... 
    Contract work

    Mindlance

    Thousand Oaks, CA
    4 days ago
  • Innova Solutions in Philadelphia, PA is seeking an Appeals & Grievances Specialist for a contract-to-hire role. The position focuses on managing appeals from receipt through resolution within regulatory timelines, analyzing benefits and evidence documents, and preparing... 
    Contract work

    MassGenics, Inc.

    Brooklyn, NY
    3 days ago
  •  ...Registered Nurse to facilitate member and provider appeals and ensure processes meet guidelines and...  ...and inventory. The role requires a valid RN license, at least 5 years of healthcare...  ...and knowledge of managed care. This is a remote/work-from-home position with standard CST... 
    Remote job
    Work from home
    Shift work

    HCSC Group

    Richardson, TX
    1 day ago
  • MJHS in New York, NY seeks an A&G Coordinator to investigate and respond to member and provider appeals and grievances under CMS and DOH rules. In a non-clinical role, you will help ensure timely decisions and accurate documentation. You will determine the appropriate... 

    MJHS

    New York, NY
    2 days ago

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to Remote Appeals & Grievances Specialist (RN/LPN/DH). Be the first to apply!