Appeals & Grievances Case Manager (Oregon)

Job Description

Job Description

Immediate need for a talented Appeals & Grievances Case Manager (Oregon)  . This is a 12+ Months Contract opportunity with long-term potential and is located in US (Remote) . Please review the job description below and contact me ASAP if you are interested.

Job ID:26-31019

Pay Range: $27 - $30/hour.  Traveler benefits as per agency package. (Benefits vary by vendor and assignment.)

Key Responsibilities:

• We are seeking a detail-oriented Case Manager – Appeals & Grievances to investigate, coordinate, and resolve member complaints, grievances, and appeals in compliance with health plan and regulatory standards. 
• This role ensures timely and fair resolutions, accurate documentation, and strong cross-functional collaboration.

Key Requirements and Technology Experience:

• 2+ years experience in Appeals, Grievances or Care Coordination in a health plan or TPA.
• Strong understanding of CMS, DMHC, and NCQA regulatory standards.
• 5+ years of Appeals & Grievances experience within a Health Plan or Managed Care organization
• Experience handling:
• Member Appeals 
• Provider Appeals 
• Claims Denials 
• Authorization Appeals 
• Benefit Determinations 
• Knowledge of:
• CMS 
• DMHC 
• NCQA 
• Medicare 
• Medi-Cal 
• Commercial Health Plans 
• Excellent written communication skills
• Experience reviewing medical records and clinical documentation

Our client is a leading Healthcare Industry and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

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