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)

Healthfirst

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 23 hours ago
Similar jobs that could be interesting for youBased on the Remote Appeals & Grievances Specialist (RN/LPN/DH) 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... 
    Remote job
    Full time
    Monday to Friday
    Shift work

    Healthfirst

    New York, NY
    2 days ago
  • Elevance Health in California is seeking an entry-level Analyst in the Enterprise Grievance & Appeals Department to review, analyze and process non-complex grievances and appeals across multiple product types, including HMO, PPO, POS, and others. You will work under guidance... 
    Remote job

    Elevance Health

    Cerritos, CA
    1 day ago
  • $23 per hour

    TEKsystems is seeking a Contract Grievances and Appeals Specialist for a fully remote role based out of Columbus, OH. The position analyzes and resolves verbal and written claims and appeals from providers and members, and prepares response letters. This is a contract... 
    Remote job
    Hourly pay
    Contract work

    TEKsystems

    Columbus, OH
    1 day 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
  • $46.37k - $60.86k

     ...Job Description Hi, we're Oscar. We're hiring a Specialist, Admin Complaints, Grievances & Appeals to join our CGA & MPCT team. Oscar is the first health...  ...into our CGA Team Lead. Work Location: This is a remote position, open to candidates who reside in: Arizona,... 
    Remote work
    Full time
    Work at office

    Oscar Health

    Dallas, TX
    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 work
    Hourly pay
    Work at office

    Molina Healthcare

    United States
    1 day 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
    23 hours ago
  •  ...Grievance & Appeals Coordinator Are you a detail-oriented managed care professional looking for an exciting work-from-home opportunity in Iowa? We are seeking a self-motivated, organized Grievance & Appeals Coordinator to join our dynamic team! In this essential role... 
    Remote work
    Work from home

    Randstad

    United States
    3 days ago
  •  ...Grievance & Appeals Coordinator Are you an analytical problem solver with a passion for healthcare managed care? We are seeking dedicated...  ...Coordinators to join our growing, collaborative team! In this fully remote role, you will analyze and resolve complex member and... 
    Remote work
    Work from home
    Home office
    Weekend work

    Randstad

    United States
    3 days ago
  • $30.35 per hour

     ...MDS Specialist On Site Full-Time (RN or LPN) ~5000 E Arapahoe Rd, Centennial, CO 80122, USA ~ Full-time ~ Compensation: USD 30 - USD 46 - hourly Company Description Christian Living Communities (CLC) | Cappella Living Solutions (CLS) are dedicated to and known... 
    Hourly pay
    Full time
    Relief
    Live in
    Work at office

    Christian Living Communities

    Centennial, CO
    4 days ago
  •  ...denials, member and provider complaints, and reconsideration and redetermination requests. Review and respond to complaints, grievances and appeals within the stated time frame for each request. Certify that providers and members are reimbursed accordingly using... 

    MDA Edge

    Irving, TX
    2 days ago
  •  ...Find your calling at Mercy! Position Details: Primary Care Nurse RN or LPN Mercy Clinic Primary Care - Watonga Monday-Friday, 40 hours per week *This is a hybrid remote position. The person hired for this role will complete at least 90 days of full-time... 
    Remote work
    Full time
    Monday to Friday
    2 days per week
    3 days per week

    Mercy

    Watonga, OK
    -21
  •  ...Looking for qualified Unit Manager (RN or LPN) to join our team! Location: Woodstock Valley...  ...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

    Woodstock, VA
    1 day ago
  • $30 - $35 per hour

     ...Now Hiring: Grievance & Appeals Specialists Are you an experienced Grievance & Appeals professional with a background in Medicare or Medicaid Managed Care? We're partnering with a leading healthcare organization that's looking to add multiple specialists to their growing... 
    Work at office
    Immediate start

    Phaxis

    New York, NY
    3 days ago
  • $31.25 - $33.65 per hour

     ...Appeals Specialist Remote GeneDx delivers personalized and actionable health insights to inform diagnosis, direct treatment, and improve drug discovery. The company is uniquely positioned to accelerate the use of genomic and large-scale clinical information to enable... 
    Remote work
    Work at office
    Work from home
    Home office

    GeneDx

    United States
    4 days ago
  • $20 - $25 per hour

    A national healthcare recruiting firm is hiring for a role focused on resolving member complaints and maintaining grievance and appeals case files. The position requires excellent writing skills and strong customer service abilities. Candidates should be willing to learn... 
    Hourly pay
    Monday to Friday

    Healthcare Support Staffing

    South San Francisco, CA
    5 days ago
  • Kelsey-Seybold Clinic in Pearland, part of the Optum family, seeks an Appeals & Grievances Coordinator to manage Medicare reconsiderations, grievances, and appeals, ensuring CMS regulatory compliance and timely resolutions. You will collaborate with Medical Director, Clinic... 

    Socket.dev

    Pearland, TX
    1 day ago
  • Alameda Alliance for Health in California is seeking a Grievance and Appeals Coordinator II who reviews, investigates, and processes non-complex member grievances for all lines of business. You will prepare written determinations and maintain documentation in the electronic... 

    Alameda Alliance for Health

    Alameda, CA
    1 day ago
  • A healthcare service company is seeking a G&A Coordinator in Detroit, MI. This role involves processing appeals, grievances, and inquiries from members, requiring strong analytical and communication skills. The ideal candidate will have a bachelor's degree and experience... 

    EPITEC

    Detroit, MI
    1 day ago
  •  ...Looking for qualified Nursing Supervisor RN or LPN to join our team! Location: Ashland...  ...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
    Afternoon shift

    Avardis Health

    Ashland, VA
    1 day ago
  • $25 per hour

     ...Job Description Job Description Job Description: The organization is seeking a dedicated and experienced Case Specialist, Grievance and Appeals to join their team on a hybrid basis. This role involves investigating and resolving member and provider complaints, benefits... 
    Hourly pay
    Contract work
    Work at office

    The Jacobson Group

    Rhode Island
    17 days ago
  •  ...Appeals Specialist Are you an analytical healthcare professional who loves solving complex puzzles without being on the phone all day? We...  ...a high-performing Utilization Management team! In this 100% remote role, you will act as the first line of defense in evaluating... 
    Remote work

    Randstad

    United States
    1 day ago
  • A healthcare staffing company is seeking a Remote Registered Nurse (RN) to specialize in triage on a PRN basis. Ideal candidates will have at least 1 year of nursing experience and an active RN license. Responsibilities include conducting patient assessments, providing... 
    Remote work
    Part time
    Relief
    Work from home

    GHR Healthcare

    Newton, NJ
    1 day ago
  •  ...calling at Mercy! The Cardiac Device Specialist (CDS) assists physicians, advanced practitioners...  ...the CDS manages patient diagnostics via remote monitoring websites, analyzes...  ...The ideal candidate will be an experienced RN with strong clinical judgment, exceptional... 
    Remote work
    Full time

    Mercy

    Festus, MO
    -21
  •  ...Baptistfirst in Alabama is seeking a Denials Management Specialist to handle disputes, validate payment issues, and generate appeals for denied claims. This role involves resolving complex accounts and requires in-depth knowledge of billing rules and payer contracts.... 
    Remote work

    Baptistfirst

    El Paso, TX
    3 days ago
  • Molina Healthcare in Kentucky is seeking a Claims Support Specialist to review and resolve member and provider complaints and communicate...  ...in line with CMS standards. The role involves researching appeals and grievances, requesting and reviewing medical records and bills,... 
    Contract work

    Molina Healthcare

    Brooklyn, NY
    4 days ago
  • $83.1k - $120.36k

     ...Position Summary: The Appeals & Grievances (A&G) unit manages Healthfirst...  ...compliant manner. The A&G Clinical Specialist is the subject matter...  ...providers. This is either a remote or on-site position located...  ...Minimum Qualifications RN, LPN, & Dental Hygienist Preferred... 
    Remote work
    Contract work
    Temporary work
    Work experience placement
    Local area

    Health First

    Florida, NY
    2 days ago
  •  ...Primary Care Nurse RN or LPNMercy Clinic Primary Care - Quailbrook (OKC)Monday-Friday, 40 hours per weekThis is a hybrid remote position. The person hired for this role will complete at...  ...an accredited school of nursing (RN or LPN).Licensure: Active nursing licensure in... 
    Remote work
    Full time
    Monday to Friday
    2 days per week
    3 days per week

    Mercy

    Oklahoma City, OK
    4 days ago
  • $45 per hour

     ...SPECTRAFORCE is seeking a Clinical Appeals Specialist to handle member-generated appeal processes remotely from California. The role involves reviewing medical records...  ...and effective communication skills. A California RN license and ADN are required. The position offers... 
    Remote work
    Hourly pay

    SPECTRAFORCE

    California, MO
    23 hours ago
  • $50k

     ...DRG Validation, Cost Outlier and Readmission reviews.  The Appeals Specialist I is responsible for performing triage, review, analysis, and...  ...under pressure in an atmosphere of frequent interruptions  Remote Work Requirements  ~ High speed internet (100 Mbps per... 
    Remote work
    Contract work
    Work experience placement

    Med Review Inc

    United States
    3 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!