Remote Grievance & Appeals Lead (RN) - Oregon
Centene Corporation
Centene seeks a Grievance & Appeals Coordinator for a remote role aligned to PST. The position handles processing of member grievances and appeals and coordinates with state agencies to ensure compliance with contractual timeframes. The role requires a Bachelor's degree (or equivalent) and 3+ years in healthcare or law related to grievances. Leadership experience in cross-functional teams is preferred; Oregon RN licensure is strongly preferred. #J-18808-Ljbffr
- ...Centene Management Company LLC is seeking a Grievance & Appeals Coordinator for a remote role aligned to Pacific Standard Time. Preference for an Oregon resident with an active RN license. You will ensure timely processing of member grievances and appeals, coordinate with...Remote work
- ...Corporation is seeking a Grievance & Appeals Manager to ensure... ...requests. The role is remote with PST hours and a strong preference for an Oregon-resident candidate with an active Oregon RN license. You will monitor... ...senior management, and lead cross-functional teams...Remote work
- ...Humana, Inc. is seeking a Grievances & Appeals Lead to support the Medicare Grievance organization by coordinating IOP oversight, driving corrective actions, and aiding CMS audit readiness. You will report on performance metrics, partner with leaders, and advise executives...Remote work
$86.3k - $118.7k
...Become a part of our caring community The Grievances & Appeals Lead supports the Medicare Grievance organization by coordinating Issue of Performance... ...member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to Humana's offices for...Remote workFull timeTemporary workWork at officeWork from homeHome office- ...Humana, Inc. is seeking a Grievances & Appeals Lead to oversee Medicare Grievance IOP activities and drive corrective actions. You will work with executives and operational leaders to manage risks, support CMS audit readiness, and monitor compliance metrics. Responsibilities...Remote work
- ...JOB DESCRIPTION Job Summary Provides lead level support for claims activities including reviewing and resolving member and... ...as team lead for submission, intervention and resolution of appeals, grievances, and/or complaints from Molina members, providers and related...Remote workContract workWork at office
- ...Centene Corp. is seeking a remote RN/LPN/LVN with 2+ years of clinical nursing experience to facilitate medical necessity grievances, appeals and denials. The role requires California licensure and PST hours. You will review clinical data, prepare case reviews for...Remote work
- ...HealthEdge Software, Inc. is seeking a contract-based professional to manage complex grievances and appeals for members and providers in a remote US-based role. The candidate will review medical necessity across inpatient, outpatient, and ancillary services and prepare...Remote workContract work
- 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
- ...Phaxis is seeking an experienced RN to own grievance and appeals cases from intake to final decision in a fully remote setting. You will handle outpatient and community-based care grievances, applying medical necessity criteria and regulatory rules. The ideal candidate...Remote work
$52 - $56 per hour
...experience Type: Contract Location: 100% remote within the U.S. Schedule: Business hours... ...: Investigate and manage clinical grievances, appeals, and external reviews from intake to resolution... ...Active, unrestricted New York State RN license. 3+ years of progressive RN...Remote workContract workAfternoon shift$53 per hour
...REMOTE RN OPPORTUNITY – GRIEVANCE & APPEALS / UTILIZATION REVIEW We're hiring experienced Registered Nurses to join a leading healthcare organization in a fully remote role! Position Details Location: Remote – Must reside in New York State Schedule: Monday–...Remote workLong term contractMonday to Friday$53 per hour
...Phaxis - Healthcare is hiring for a REMOTE RN opportunity focused on Grievance & Appeals and Utilization Review. The role requires candidates to reside in New York State and hold an active NY RN license. The schedule is Monday–Friday, 9 AM–5 PM, with compensation at...Remote workLong term contractContract workMonday to Friday$52 - $56 per hour
...Job Description Job Description Now hiring: Remote UM / Grievance & Appeals RN (NY License) | Contract | $52–56/hr Are you an RN who has owned appeals cases from intake to final decision letter? We want to talk to you. Our client, a New York health plan, needs...Remote jobContract workImmediate start$91.25k
...Grievance & Appeals Nurse, RNFind joy in serving others with IEHP! We welcome you to join us in "healing and inspiring the human spirit" and... ...Supervisor, Grievance & Appeals, the Grievance & Appeals Nurse, RN (G&A Nurse, RN) is responsible for working directly with the...Remote workTemporary workImmediate start- Phaxis is hiring a Remote UM / Grievance & Appeals RN (NY License) for a contract role with a New York health plan. If you have owned appeals from intake to final decision letter, we want to talk to you. You will review medical necessity for outpatient and community-based...Remote jobContract work
- ...LLC is seeking a nurse to facilitate medical necessity grievances, appeals and denials while reviewing clinical data to determine if criteria are met. The role requires California RN/LPN licensing and supports remote work with PST hours. Responsibilities include...Remote job
- ...Humana, Inc. is seeking a Grievances & Appeals Lead to coordinate IOP oversight, drive corrective actions, and support CMS audit readiness. You will work with grievance teams and operational leaders to reduce compliance risk while advancing quality goals. The role reports...Remote work
- Harbor Health is seeking an experienced Appeals & Grievances Manager to lead and optimize our complaint, grievance, and appeals operations in a fully remote, nationwide capacity. You will manage a remote team, drive process improvements, and ensure compliance with federal...Remote job
$27 - $30 per hour
...Immediate need for a talented Appeals & Grievances Case Manager (Oregon) . This is a 12 Months Contract opportunity... ...potential and is located in US(Remote) . Please review the job... ...documentation Our client is a leading Healthcare Industry and we are currently...Remote workContract workTemporary workLocal areaImmediate start- ...UnitedHealth Group is seeking a Clinical Grievances Nurse to review retrospective cases and current cases ensuring appropriate care and... ...addressing immediate member needs. This role offers PST hours with remote work options and a Monday–Friday schedule.You will perform...Remote workImmediate startMonday to Friday
$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- ...Centene Corporation in Oklahoma City seeks an experienced RN to lead the Prior Authorization, Concurrent Review, Retrospective Review, and Appeals teams, ensuring compliant utilization management. This role oversees UM processes, guides standards, analyzes utilization...Remote workWeekend work
- ...Supervising the daily operations of the Appeals and Grievance team, the full-time remote Supervisor of Appeals and Grievances will ensure productivity and quality metrics are met while supporting staff on escalated issues and monitoring case loads across multiple states...Remote workFull time
$73.01k - $111.97k
...Must work PST Hours JOB DESCRIPTION Job Summary Leads and supervises team responsible for claims activities including... ...responsible for the submission/resolution of member and provider appeals and grievances, and ensures resolutions are compliant with applicable...Remote workFull timeWork at office$56.2k - $101k
...Position Purpose: Supervise the day to day operations of the Appeals and Grievance (A&G) staff and functions within the department ensuring... ...and distribute case load. Key Details : This position is remote/work from home. The role will support the states of Delaware...Remote workFull timePart timeWork at officeWork from homeMonday to FridayFlexible hoursWeekend work$56.2k - $100.98k
...Position Purpose: Facilitate medical necessity grievance, appeals and denials including disposition of denials notification... ...met Key Details : Candidate must hold California RN Licensure. This position is remote and will work PST hours. Review clinical data to...Remote workHourly payFull timePart timeWork at officeFlexible hours- ...Oscar Health is seeking a CGA Team Lead to supervise daily CGA production operations and guide staff to meet performance targets. You... ...CGA & MPCT, and may involve projects outside daily operations. Remote work is available for eligible states with occasional travel for...Remote work
- ...Cambia Health is seeking an Appeals Clinician I to work from home across Oregon, Washington, Idaho or Utah. You will apply nursing expertise to complete clinical... ...education of non-clinical staff. BSN and an active RN license with 3 years of clinical experience are...Remote workWork from home
- ...Cambia Health is seeking an Appeals Clinician I to work remotely from home within Oregon, Washington, Idaho or Utah. You will apply nursing expertise to complete... ...requires a Bachelor's Degree in Nursing and an active RN license in one of the eligible states, plus 3 years...Remote workWork from home
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