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 12 hours ago
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Atlanta, GA12 hours ago - ...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
L.A. Care Health Plan
Los Angeles, CA3 days ago $45.9k - $78.6k
...quality service is the norm and every member feels valued. The Appeals & Grievances Specialist plays a vital role in ensuring fair, timely, and... ...with Microsoft Word, Excel, and Outlook This position is a Remote role.To be eligible for consideration, candidates must have...Remote workWork experience placementMedica
Minnetonka, MN2 days ago$21.16 - $38.37 per hour
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Phoenix, AZ4 days ago$60.78k
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Los Angeles, CA3 days ago$70k - $80k
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Cary, NC3 days ago- 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
$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- ...To support a remote team, the full-time Healthcare Appeals Specialist will analyze, triage, and process complaints and appeals related to dental and vision... ...process standard and escalated appeals, complaints, and grievances from members, providers, and health plans...Remote workFull time
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United States2 days ago $48.6k - $83.16k
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New York, NY2 days ago$21.16 - $38.37 per hour
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Irving, TX3 days ago $32 - $33 per hour
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United States4 days 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- ...Detail-oriented and analytical, the remote Billing & Appeals Specialist will manage provider billing disputes and appeals, ensuring accurate resolutions while maintaining exceptional customer service in a contract role. Key responsibilities Review, investigate, and resolve...Remote workContract workWork at office
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United States4 days ago $19 - $21 per hour
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$29.7 - $31.8 per hour
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Atlanta, GA3 days ago $65k - $85k
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Crystal Lake, IL3 days ago$83.1k - $120.36k
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