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 4 days ago
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...Your Role The Appeals and Grievances team is responsible for clinically reviewing member appeals and grievances that are the result of either a... ...preservice, post-service or claim denial. The Appeals and Grievances RN Senior will report to the Manager of the Appeals and...Full timePart timeWork at officeLocal areaWork from homeHome officeMonday to FridayShift work2 days per week- ...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...
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Millersville, MD5 days ago
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