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$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$60.78k - $91.17k
...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 workFull timeLocal areaShift workWeekend work- ...To support a growing remote team, the full-time Appeals and Grievance Specialist will manage and resolve complaints, grievances, and appeals from members and providers while ensuring compliance with applicable requirements. Key responsibilities Manage and resolve complaints...Remote workFull time
$95k - $115k
Western Health Advantage seeks an Appeals & Grievances Nurse (RN) for their Utilization Management team in Sacramento, CA. This full-time role offers a salary between $95,000 and $115,000 annually. The nurse will collaborate with various stakeholders to ensure compliance...Full time$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 workFull timeContract workMonday to Friday$45.9k - $78.6k
...service is the norm and every member feels valued. Medica's Appeals and Grievance Specialist plays a vital role in ensuring our members and providers... ...Microsoft Word, Excel, and Outlook This position is a Remote role.To be eligible for consideration, candidates must have...Remote workWork experience placement- Medix is seeking an LPN/LVN or RN with 1-2 years of appeals experience and clinical acute care background for a remote, full-time role. Training is 9am-4pm EST, with flexible start/end times to complete a 40-hour week, Monday through Friday. The position supports complex...Remote jobFull timeMonday to FridayFlexible hours
$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$30.81 - $39.82 per hour
...Incident Management Specialist III, Grievances and Appeals Primary Location Corona, California Employee Status: Regular Worker Location: Remote Schedule Full-time Scheduled Weekly Hours: 40 Shift Day Salary $30.81 - $39.82 / hour Job Number 1442654 Date Posted 08/2...Remote workFull timeWork at officeShift work- ...Group in the United States is seeking a healthcare appeals specialist. The role requires an active RN or LPN license, a 40-hour work week, Monday to Friday, with mandatory holiday and weekend rotations. Fully remote opportunities are available to applicants in any U.S...Remote jobMonday to Friday
- Providence Health & Services is seeking an Appeals RN in Case Management for a remote, per diem role working 8-hour day shifts. The Care Management Recovery Advocate will manage clinically-based appeals between Providence California Region and outside payers, focusing...Remote jobDaily paidDay shift
- Solü Technology Partners in Phoenix, AZ seeks a Med Appeals & Grievance Specialist Coordinator to lead clinical and administrative CMS grievance/appeal workstreams for Part C and Part D. You will investigate member, provider and claims issues, ensure timely investigations...
$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- 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
$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- ...Appeals And Grievances Specialist Will the position be 100% remote? Yes. Are there any specific location requirements? No. Are there any time zone requirements? Prefer eastern time zone. What are the must have requirements? Experience working in A&G, ability to prioritize...Remote workContract work
$56.27k - $69.9k
...Appeals or Grievances Specialist II Working Title: Appeals Specialist II FLSA Status: Exempt Posting Salary Range: $56,270 - $69,898 Office Location: Remote within North Carolina. Make an Impact Trillium Health Resources is a Tailored Plan and Managed...Remote workWork at officeLocal areaImmediate startWork from homeFlexible hours$14.9 - $29.06 per hour
...(CMS). 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. Elevates appropriate appeals to the next level for review....Hourly payWork experience placementWork 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 jobHourly payWork at office- ...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
- Santa Barbara Cottage Hospital is seeking a Grievance and Appeals Nurse for a remote position based in Indiana. Responsibilities include investigating complex... ...need at least 2 years in managed care and an IN RN license, with MCG experience and preferred CMCN. #J-188...Remote job
- ...Appeals & Grievance Specialist Schedule Monday – Friday Onsite Position Position Summary The Appeals & Grievance Specialist II is responsible for independently researching, reviewing, and resolving member and provider inquiries, complaints, appeals, and grievances. This...Work at officeMonday to Friday
- 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
- ...Appeals and Grievance Specialist II (Managed Care) – Irving, TX | 12-Week Contract Location: Irving, TX Job Type: 12-Week Contract Company: Sigma Inc. Schedule: Monday–Friday | 8-Hour Shifts Join Our Team as an Appeals and Grievance Specialist II! Sigma Inc....Contract workMonday to FridayShift work
$65k - $75k
...If you want to use your talents to transform healthcare in the United States, come join us! About the Role As an Appeals and Grievances Specialist, you'll own the end-to-end handling of member and provider appeals and grievances, investigating cases, coordinating with...- ...Unit Manager (RN or LPN) Looking for qualified Unit Manager (RN or LPN) to join our team... ...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
- ...Appeals And Grievance Specialist II This position requires the ability to work independently researching and reviewing inquiries from members and providers. Also requires knowledge of benefit interpretation, claims reviews, CPT and ICD coding. Responsible for reviewing...
- A national recruiting company is seeking a Grievance/Appeals Representative in Thousand Oaks, CA. The role involves reviewing claims, investigating customer grievances, and ensuring resolution of appeals. Candidates must possess a high school diploma and have 1 to 3 years...Contract work
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