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
- 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
$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- ...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 workWork from home
- ...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 workFull timeWork at office
- ...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 workWork at office
$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$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 workWork experience placement- 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 HumanaRemote job
$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 workLocal areaShift workWeekend work- 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 jobWork at office
- 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
$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 workMonday to Friday- 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 jobWeekend work
- ...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 jobPart timeWeekend work
$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 workHourly payPermanent employmentTemporary workWork experience placementShift work- 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
- ...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
$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- ...Looking for qualified Weekend Nurse (RN or LPN) to join our team! Location: Arden Ridge Health... ...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
$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 payWork experience placement$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 workHourly payPermanent employmentContract workTemporary workMonday to Friday$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 placementWork at officeFlexible hours- 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
- ...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
- ...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 workFull timeLocal areaShift workNight shiftDay shiftAfternoon shift
- At Molina Healthcare, the Claims Appeals Specialist provides support for handling member and provider complaints, aligning with CMS standards... ...focuses on researching and resolving appeals, disputes, and grievances with timely communications to authorized representatives....
$29.32 - $36 per hour
Appeals And Grievances SpecialistLocation: Los Angeles, CAOnsite Flexibility: HybridPosition Type: ContractContract Duration: 3 months (extensions... ...at this time.Job SummaryThe Appeals and Grievances (A&G) Specialist will receive, investigate, and resolve member and provider...Local areaWork visaShift workDay shift- The Metropolitan Jewish Health System, Inc. is seeking a coordinator to investigate and respond to written or verbal appeals and grievances from members and providers, ensuring adherence to CMS, DOH, and contract requirements. You will determine service type, manage timelines...Contract work
- 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...
- 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...
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