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
- ...skilled professional for a clinical role addressing provider appeals and grievances. This position demands expertise in managed care while ensuring... ...ideal candidate will possess a relevant degree, an active RN license, and several years of experience in healthcare, particularly...Remote job
$81.1k - $116.48k
Position Summary: The Appeals & Grievances (A&G) unit manages Healthfirst member... ...manner. The A&G Clinical Specialist is the subject matter... ...providers. This position is 100% Remote. We are hiring for the... ...Minimum Qualifications: RN, LPN OR Dental Hygienist Preferred...Remote jobContract workTemporary workWork experience placementLocal areaMonday to FridayShift work- ...Med Appeals & Grievance Specialist Coordinator Top Healthcare Company is hiring an RN to work remotely as a Med Appeals & Grievance Specialist Coordinator! Must have a current RN License in Arizona or a Compact RN license. Duties include performing in-depth analysis...Remote work
- ...positions are classified as hybrid, onsite or remote. While the majority of our employees are... ...to requests for member and provider appeals, grievances, reconsiderations and corrected claims... ...a compact state as a Registered Nurse (RN) Required Certifications N/A Preferred Qualifications...Remote workFull timeContract workWork experience placementWork at officeLocal area1 day per week
- ...Geisinger is seeking a dedicated professional to support the administration of the Appeals and Grievance process. The role involves acting as a liaison between members and the Plan regarding denied claims, services, and other concerns. Responsibilities include managing...Remote work
- ...L.A. Care Health Plan is seeking an Appeals and Grievances Specialist II in Los Angeles, CA. The role involves investigating member and provider complaints, ensuring compliance with various health regulations, and preparing reports. Requirements include at least 2 years...Remote workFull time
- Top Healthcare Company is hiring an RN to work remotely as a Med Appeals & Grievance Specialist Coordinator! ***Must have a current RN License in Arizona or a Compact RN license*** Duties: - Perform in-depth analysis, clinical review and resolution of provider appeals...Remote workContract workTemporary workWork experience placementWork at officeLocal area
$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...Remote workHourly payFull timeContract workWork experience placementWork at office- ...Associate to perform ongoing clinical review and adjudication of appeals and grievances. You will collaborate with a team of medical directors,... ...spanning PPO, HMO, MAPD, and PDP programs. The role supports remote work within the United States, with standard Monday-Friday...Remote jobMonday to Friday
- UnitedHealthcare is seeking a Physician Associate to review and adjudicate appeals and grievances across multiple health plans. You will join an integrated... ..., and appeals staff to deliver timely determinations. This remote role requires a current PA license, NCCPA certification, and...Remote jobWeekday work
- ...UnitedHealthcare unit seeks a Physician Associate to review and adjudicate appeals and grievances across multiple health plans. You will work under medical... ...and maintain high standards of care. This full-time remote role requires state PA licensure, NCCPA certification, 5+...Remote jobFull time
- ...Hill Valley Healthcare Corporate is seeking an experienced ADR Specialist (RN or LPN) to support our Skilled Nursing Facilities. This is a 100% remote position, ideal for MDS experts looking to ensure regulatory compliance and optimize reimbursement accuracy across multiple...Remote work
$60.78k
Appeals and Grievances Specialist II Job Category: Customer Service Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID:... ...requires work after hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in hours/shift in...Remote workFull timeLocal areaShift workWeekend work$70k - $80k
Piper Companies is seeking a Remote Clinical Appeals Analyst to provide clinical expertise in reviewing and resolving complex member and provider... ...must hold an active North Carolina licensure as an RN, LPN, PT, or OT and have significant clinical experience. The salary...Remote jobFull timeContract workMonday to Friday- L.A. Care Health Plan in Los Angeles, CA is seeking a Lead Appeals and Grievances RN to help develop and lead a cohesive A&G clinical unit. The... ...and extensive knowledge of healthcare regulations. A hybrid remote schedule is supported along with after-hours responsibilities...Remote job
$30.5 - $41 per hour
...Cardiovascular Medicine, PLLC is seeking a Registered Nurse (RN) or Licensed Practical Nurse (LPN) to join our Device Clinic team. If you have strong... ...limited patient assessments. Processing and scheduling remote device checks. Handle telephone triage of incoming...Remote workWork at officeLocal areaMonday to FridayWeekend work$102.18k
...Lead Customer Solution Center Appeals and Grievances RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA... ...requires work after hours, on weekends, holidays, a hybrid remote schedule, and occasional flexibility in hours/shift in critical...Remote workFull timeShift workWeekend work- ...Schedule: The position is 100% Remote, and the candidates must reside in Southern California Description: The Temporary Grievance & Appeals Nurse (LVN) is responsible for managing and coordinating grievance and appeal cases in compliance policies and state and federal...Remote workTemporary workWork at officeImmediate start
$26 - $32 per hour
...with our members’ culture and values. Job Summary The Appeals & Grievances Resolution Specialist supports the intake, investigation, and resolution of... ...quickly. Work is performed in an office environment and/or remotely. The job involves frequent contact with staff and...Remote workHourly payWork at office- ...Grievance And Appeals Nurse Top healthcare company is looking for a registered nurse to work remotely as a grievance and appeals nurse. Must hold an Arizona RN license. This position serves as a clinical and administrative subject matter expert for Part C and Part...Remote work
$71.59k - $116.48k
...healthcare organization is seeking an A&G Clinical Specialist to manage health member complaints and appeals. This fully remote position requires expertise in clinical case... .... The ideal candidate should be an RN, LPN or Dental Hygienist with experience in appeals...Remote job- Blue Cross Blue Shield of Arizona needs a clinical expert for managing member and provider appeals. This remote position requires strong accuracy, knowledge of compliance timelines, and a focus on customer service. Applicants should possess a healthcare-related degree...Remote job
$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$50k - $55k
.... Under the direction of the Appeals Department leaders, the Appeals... ...the department. The Appeals Specialist level II performs research,... ...investigation, and analysis of appeals, grievances, and other types of... ...frequent interruptions Remote Work Requirements High speed...Remote work$13.41 - $29.06 per hour
...). Essential Job Duties Enters denials and requests for appeals into information system and prepares documentation for further... ...language for letters and prepares responses to member appeals and grievances. Elevate appropriate appeals to the next level for review....Hourly payFull timeWork experience placementWork at office- ...Sagility is seeking an Appeals and Grievance Coordinator who will manage and resolve member and provider complaints while adhering to regulatory requirements. This role involves conducting investigations, documenting actions, and ensuring compliance. As a key contact for...Remote workWork from home
- ...Member Complaint Resolution Specialist 100% remote candidates must live in one of the preferred 15 states (AZ, FL, GA, ID, IA, KY,... ...for the comprehensive research and resolution of the appeals, dispute, grievances, and/or complaints from Molina members, providers and...Remote workContract workLive inMonday to Friday
- ...Responsible for processing expedited appeals: those that are complex in nature, require... ...times of the Expedited Appeal unit, the Specialists are required to work weekends and holidays... ...versed in all aspects of the complaint, grievance and appeal process and be able to...Remote workHourly payContract workWeekend work
$45.9k - $78.6k
...connected care, where coordinated, quality service is the norm and every member feels valued. Position Summary Medica's Appeals and Grievance Specialist plays a vital role in ensuring our members and providers receive clear, timely, and accurate resolutions to their...Work experience placementWork at office3 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 Medicare...
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