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
$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- 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
$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 jobHourly payContract 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$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 workFull timeWork at office$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 workHourly payWork at office- ...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 workTraineeship
- ...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 workWork from home
- ...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 workWork from homeHome officeWeekend work
$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 payFull timeReliefLive inWork at office- ...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...
- ...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 workFull timeMonday to Friday2 days per week3 days per week
- ...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 workFull timeLocal areaShift workNight shiftDay shiftAfternoon shift
$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 officeImmediate start$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 workWork at officeWork from homeHome office$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 payMonday to Friday- 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...
- 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...
- 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...
- ...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 workFull timeLocal areaShift workNight shiftWeekend workAfternoon shift
$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 payContract workWork at office- ...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
- 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 workPart timeReliefWork from home
- ...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 workFull time
- ...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
- 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
$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 workContract workTemporary workWork experience placementLocal area- ...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 workFull timeMonday to Friday2 days per week3 days per week
$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 workHourly pay$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 workContract workWork experience placement
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