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
$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- ...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 workHourly payWork at office- ...Grievance & Appeals Coordinator Are you a detail-oriented managed care professional looking for an exciting work-from-home opportunity in Iowa? We are seeking a self-motivated, organized Grievance & Appeals Coordinator to join our dynamic team! In this essential role...Remote workWork from home
- ...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...Suggested
$30.35 per hour
...MDS Specialist On Site Full-Time (RN or LPN) ~5000 E Arapahoe Rd, Centennial, CO 80122, USA ~ Full-time ~ Compensation: USD 30 - USD 46 - hourly Company Description Christian Living Communities (CLC) | Cappella Living Solutions (CLS) are dedicated to and known...Hourly payFull timeReliefLive inWork at office- ...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
- ...Looking for qualified Unit Manager (RN or LPN) to join our team! Location: Grayson Health... ...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
$25 per hour
...Job Description Job Description Job Description: The organization is seeking a dedicated and experienced Case Specialist, Grievance and Appeals to join their team on a hybrid basis. This role involves investigating and resolving member and provider complaints, benefits...Hourly payContract workWork at office$31.25 - $33.65 per hour
...Appeals Specialist Remote GeneDx delivers personalized and actionable health insights to inform diagnosis, direct treatment, and improve drug discovery. The company is uniquely positioned to accelerate the use of genomic and large-scale clinical information to enable...Remote workWork at officeWork from homeHome office- ...Looking for qualified Nursing Supervisor (RN or LPN) to join our team! Location:... ...concerns from residents and families, ensuring grievances are handled professionally and effectively... ...adults. From telemedicine services and remote health monitoring to advanced diagnostic...Remote workFull timeLocal areaShift workNight shiftWeekend workDay shiftAfternoon shift
- ...Appeals Specialist Are you an analytical healthcare professional who loves solving complex puzzles without being on the phone all day? We... ...a high-performing Utilization Management team! In this 100% remote role, you will act as the first line of defense in evaluating...Remote work
- 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
- ...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
- ...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
$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$50k
...DRG Validation, Cost Outlier and Readmission reviews. The Appeals Specialist I is responsible for performing triage, review, analysis, and... ...under pressure in an atmosphere of frequent interruptions Remote Work Requirements ~ High speed internet (100 Mbps per...Remote workContract workWork experience placement$23 per hour
We are hiring for Appeals Specialists with our Heathcare client! These positions are 100% remote TX based. Please inquire if other positions are available if you reside outside of TX. Temp roles to start with opportunity for perm conversion. Pay Rate: $23/hr Hours: M...Remote workHourly payPermanent employmentTemporary workWork experience placementShift 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
- ...Primary Care Nurse RN or LPNMercy Clinic Primary Care - Quailbrook (OKC)Monday-Friday, 40 hours per weekThis is a hybrid remote position. The person hired for this role will complete at... ...an accredited school of nursing (RN or LPN).Licensure: Active nursing licensure in...Remote workFull timeMonday to Friday2 days per week3 days per week
- ...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
- ...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
$45 per hour
...SPECTRAFORCE is seeking a Clinical Appeals Specialist to handle member-generated appeal processes remotely from California. The role involves reviewing medical records... ...and effective communication skills. A California RN license and ADN are required. The position offers...Remote workHourly pay- ...to support patient admissions. Candidates must have a valid California RN license and at least two years of clinical experience or a Master's degree in a related field. The position offers remote work with emphasis on critical thinking and problem-solving skills. #J-1...Remote work
- ...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
$45 - $60 per hour
...Care Provider (PCP) or RN in a timely manner; d.... ...Management Nurse, LVN/LPN (Work from home) LICENSED... ...Revised: 01-17-25) Maryland Remote Patient Monitoring LPN... ...00-$60.00 6 months ago Grievance and Appeals Nurse-LVN 25-00254 (24-25) Health Care Specialist / Licensed Vocational...Remote workFull timeContract workTemporary workPart timeFor contractorsWork from homeRelocation packageShift work$22.99 per hour
...analytical problem solver with a passion for healthcare managed care? We are seeking dedicated Grievance & Appeals Coordinators to join our growing, collaborative team! In this fully remote role, you will analyze and resolve complex member and provider appeals and grievances,...Remote workHourly payPermanent employmentTemporary workWork experience placementWork at officeWork from homeHome officeShift workWeekend work- ...HEDIS Auditor RN/LPN Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional... ...depending on how quickly candidate catches up. There is weekly onsite meeting which candidate must attend and remote other days....Remote workContract workWork from home
$32.13 - $48.2 per hour
...Role-Specific Expectations:Registered Nurse (RN):Holds full accountability for independent... ...of individualized care plans.Supervises LPN and nursing assistant clinical work.May... ...reports and documentation with RN review as appropriate.Remote TypeSalary Range:$32.13 - $48.20...Remote workRelocation packageShift work- ...TurningPoint Healthcare Solutions is hiring a Utilization Review Nurse to work remotely. The ideal candidate must hold a valid LPN or RN license and possess strong critical thinking and clinical expertise. Responsibilities include performing initial clinical reviews, assisting...Remote work
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