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 2 days ago
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$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- ...Managing the resolution process for medical and pharmacy member appeals and grievances, the full-time remote Appeals and Grievance Specialist will ensure compliance with regulatory requirements and accreditation standards while coordinating with internal and external stakeholders...Remote workFull time
Virtual Vocations Inc
United States1 day ago $60.78k
...Appeals And Grievances Specialist II Job Category: Customer Service Department: Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position... ...work after hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in hours/shift in critical...Remote workFull timeLocal areaShift workWeekend workLOS Angeles Care Health Plan
Los Angeles, CA3 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 workHourly payFull timeContract workWork experience placementWork at officeMolina Healthcare
Phoenix, AZ14 hours 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
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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$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 officeOscar Health
Dallas, TX10 days ago- ...Appeals And Grievances Rn Senior 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...Full timePart timeWork at officeLocal areaWork from homeHome officeMonday to FridayShift work2 days per week
Blue Shield Of California
Rancho Cordova, CA5 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 jobHourly payWork at office- ...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 workFull time
RegalCare
Holyoke, MA19 days ago - ...Looking for qualified Unit Manager (RN or LPN) to join our team! Location: Middleton Oaks... ...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 areaMonday to FridayShift workNight shiftDay shiftAfternoon shift
Avardis Health
Winona, MS4 days 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 officeImmediate start- ...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
Mercy
Watonga, OK2 hours 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 payMonday to Friday- ...Description Looking for qualified Weekend Nurse (RN or LPN) to join our team! Location: Arden... ...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 workDay shiftAfternoon shift
Avardis Health
Arden, NC3 days 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...
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$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 officeThe Jacobson Group
Rhode Island24 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
- ...Managing and processing appeals efficiently, the Appeals Specialist II will work in a flexible environment with both remote and on-site options, reviewing case documentation and communicating with clients to resolve issues. Key responsibilities Manage and process appeals...Remote workFlexible hours
Virtual Vocations Inc
United States2 days 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 workFull time
Mercy
Festus, MO2 hours ago $248.5k - $373k
.... Growing together.Work at home!You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities:The Appeals and Grievances Medical Director is responsible for ongoing clinical review and adjudication...Remote workMinimum wageWork experience placementLocal areaWork from home- ...oriented nurse to join our Intake team. This role is ideal for an RN or LPN who enjoys patient education, care coordination, and ensuring... ...training and demonstrated proficiency in the role, occasional remote work opportunities may be available based on departmental needs...Remote workFull timeCasual workPrivate practiceWork at officeMonday to FridayFlexible hoursWeekend work
GASTROENTEROLOGY SPECIALTIES PC
Lincoln, NE3 days ago $22.74 - $27.79 per hour
...Appeals Specialist Remote (WFH) At Adaptive, we're Powering the Age of Immune Medicine. Our goal is to harness the power of the adaptive immune system to transform the way diseases are diagnosed and treated. As an Adapter, you'll have the opportunity to make...Remote workHourly payWork at officeWork from homeHome officeNight shiftAdaptive Biotech
United States4 days ago- ...Working remotely in a full-time capacity, the Appeals Specialist will perform moderately complex appeals work, including researching inquiries and responding to providers and beneficiaries while managing phone discussions and documentation processes. Key responsibilities...Remote workFull timeFor contractorsWork at office
Virtual Vocations Inc
United States1 day ago - UT Southwestern Medical Center is seeking a Technical Denials Management Specialist II in the Revenue Cycle Department to review, research, and resolve claim denials and appeals for various insurers, while identifying payment trends to maximize collections. This WFH role...Remote jobWork at officeWork from home
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Quadax
Middleburg Heights, OH1 day ago - ...Looking for qualified Wound Care Nurse (RN or LPN) to join our team! Location: Middleton... ...as the primary contact between the Wound Specialist Physician and the nursing team, ensuring... ...adults. From telemedicine services and remote health monitoring to advanced diagnostic...Remote workFull timeLocal areaShift workNight shiftDay shiftAfternoon shift
Avardis Health
Winona, MS5 days ago $16 - $18.45 per hour
...Position: Appeals Specialist Location: Remote, US Salary: $16.00-18.45 hourly Overview J29, Inc. (J29) has been supporting commercial, State, and Federal health and human service programs since company inception in 2017 as a healthcare management consulting...Remote workHourly payFull timePart timeFor contractorsWork at officeJ29 Inc.
Eastern, KY2 days ago- ...members to join our clinical team. This role is ideal for an RN or LPN who enjoys patient education, care coordination, and building... ...:30pm and 5:00pm Enjoy most Friday afternoons off! Hybrid remote work may be available following successful completion of training...Remote workFull timePrivate practiceWork at officeMonday to FridayFlexible hours
GASTROENTEROLOGY SPECIALTIES PC
Lincoln, NE27 days ago
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