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
- ...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
$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 work$23 per hour
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$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$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 office- Our client is seeking an experienced Grievance and Appeals Specialist with strong health plan industry experience to join their team. The Grievance and Appeals Specialist is responsible for reviewing, investigating, and resolving member and provider grievances and appeals...
- ...General Brigham Health Plan is seeking an Appeals Coordinator to coordinate, process,... ...and ensuring regulatory compliance in a remote environment within the United States. Ideal... ...will have 3-5 years in health plan appeals/grievances, strong customer service, and excellent...Remote job
$47.84k - $54.08k
...applications and next steps. Our partner is looking for a Grievance Specialist based in the United States. This fully remote role focuses on resolving member grievances... ...experience handling Medicare Advantage appeals and grievances ; Medicare experience is required...Remote workHourly payFull time- ...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
$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- ...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
- ...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
- ...Baptistfirst in Alabama is seeking a Denials Management Specialist to handle disputes, validate payment issues, and generate appeals for denied claims. This role involves resolving complex accounts and requires in-depth knowledge of billing rules and payer contracts....Remote work
- ...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
- A healthcare staffing company is seeking a Remote Registered Nurse (RN) to specialize in triage on a PRN basis. Ideal candidates will have at least 1 year of nursing experience and an active RN license. Responsibilities include conducting patient assessments, providing...Remote workPart timeReliefWork from home
- ...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
- ...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
$60.32k - $74.88k
...The Transfer Center Specialist II (RN) will work remotely and coordinate through inbound and outbound calls the acceptance of patients into LifePoint Health system and facilitates patient transfer process with patients going out of LifePoint Health system to non-LifePoint...Remote workFull timeLocal areaFlexible hours$32.13 - $48.2 per hour
...Specific Expectations: Registered Nurse (RN): Holds full accountability for... ...individualized care plans. Supervises LPN and nursing assistant clinical work. May... ...documentation with RN review as appropriate. Remote Type Salary Range: $32.13 - $48.20Remote workRelocation packageShift work- ...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
- ...Overview: Respond to all assigned levels of denials by submitting appeal letters and required documentation to insurance companies within... ...plan and work with the patient to get the denial overturned. Remote: Although this position is listed as remote, the training period...Remote work
$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 office$83.1k - $120.36k
...Position Summary: The Appeals & Grievances (A&G) unit manages Healthfirst... ...compliant manner. The A&G Clinical Specialist is the subject matter... ...providers. This is either a remote or on-site position located... ...Minimum Qualifications RN, LPN, & Dental Hygienist Preferred...Remote workContract workTemporary workWork experience placementLocal area- ...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
$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- Leewood Healthcare Center is seeking a skilled Wound / Treatment Nurse (RN or LPN) to coordinate and provide wound care and prescribed treatments for residents. This role emphasizes skin integrity, healing outcomes, regulatory compliance, and overall quality of care. We...Full timePart timeDay shift
$59.25k - $94.8k
...Omaha, NE (Nebraska); Work from Home Work Arrangement: Remote : Work at home employee residing outside of a commutable distance... ...We are excited to bring on a Short Term Disability Appeals Specialist to our team within Workplace Solutions. As an Appeals Specialist...Remote workFull timeContract workTemporary workWork experience placementWork at officeWork from homeRelocation package- ...for a 10-month contract role primarily focused on reviewing clinical data and managing member appeal requests in accordance with company policies. The position allows for remote work, preferably from Iowa, with possible on-site visits. Key responsibilities include...Remote workContract work
- Aspirion in Delray Beach, FL is seeking a Denials Appeals Specialist to analyze denial reasons, draft persuasive appeal letters, and submit appeals to insurance carriers. Your work will support cash flow, reduce aging, and minimize revenue leakage through timely, high-...Remote job
- ...Job Description Job Description LTSS Appeals Nurse (Remote) We are seeking a detail-oriented,... ...unrestricted New York Registered Nurse (NY RN) license. Residency: Must reside in... ...utilization review, appeals, grievances, or clinical management activities....Remote workLocal areaMonday to FridayFlexible hoursShift work
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