Remote Case Manager - Appeals & Grievances (Health Plan)
Pyramid Consulting, Inc
- Remote job
Pyramid Consulting, Inc is seeking a talented Case Manager – Appeals & Grievances for a 06+ months contract based in California (Remote). The role involves investigating and resolving complaints in compliance with health plan standards. Ideal candidates will possess 3+ years of relevant experience and have a thorough understanding of regulatory requirements. Employee benefits include health insurance, a 401(k) plan, and paid sick leave. #J-18808-Ljbffr Pyramid Consulting, Inc
$20 - $30 per hour
...Case Manager Appeals & Grievances (California) Immediate need for a talented Case Manager... ...is located in California (Remote). Please review the job description... ..., but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (...Remote workHealth InsuranceContract workLocal areaImmediate start- ...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... ...preparing reports. Requirements include at least 2 years in Managed Care, knowledge of medical terminology, and excellent...Remote workHealth InsuranceFull time
- Mass General Brigham Health Plan Holding Company, Inc. is seeking a Duals Supervisor for Appeals and Grievances to lead a team responsible for overseeing the appeals process. The ideal candidate will have significant experience in healthcare appeals and grievances, regulatory...Remote jobHealth Insurance
- ...Grievances And Appeals Nurse Pride Health is hiring a Grievances and Appeals Nurse... ...-known client! (Remote Contract) Schedule... ...of Health Plan operations and business... ...grievance and appeal cases Collects and analyzes... ...experience in a managed care environment (preferred...Remote workHealth InsuranceContract workWork experience placementLocal areaDay shift
- ...A-Line Staffing is hiring a Grievance & Appeals Coordinator in the Natomas or... ...or Woodland Hills, CA Remote but may need to travel to the... ...Experience working with complex cases or compliance-related tasks... ...Regulations - Understanding of health plan compliance, regulatory...Remote workHealth InsuranceBi-weekly payFull timeContract workWork at officeLocal areaImmediate startMonday to Friday
$102.18k
...Customer Solution Center Appeals and Grievances RN Job Category:... ...in 1997, L.A. Care Health Plan is an independent public... ...clinical A&G cases for all lines of business... ...provide feedback to management on performance of staff... ..., holidays, a hybrid remote schedule, and occasional...Remote workHealth InsuranceFull timeShift workWeekend work- ...CA / Portland, OR - Remote Duration: 12+ Months... ...respond to member grievances and appeals Top (3) Required... ...grievance and appeals case processing. Strong... ...and time management skills. Ability to... ...other stakeholders of Health Plan's determinations....Remote workHealth InsuranceContract workMonday to FridayShift work
$23.22 - $34.84 per hour
A leading health insurance provider is seeking a Grievance & Appeals Coordinator to work virtually full-time, with responsibilities including summarizing complaints, ensuring resolution of grievances, and documenting interactions. The ideal candidate should possess a high...Remote workHealth InsuranceHourly payFull time$21 - $25 per hour
...Appeal And Grievance Coordinator One of Airetel Staffing's valued clients is... ...the internal appeal process remote M-F (8-hr shift that will start... .... Timely assignment of cases is critical to ensure member... ...least 1 year of experience in health insurance claims and appeals...Remote workHealth InsuranceShift work- ...Job Summary Appeal & Grievance Coordinator Reviewer I (Remote PST Preferred) Location: Remote (PST Preferred) Duration: 5+ Month Contract Key Responsibilities... ..., vendors, and internal teams. Maintain accurate case documentation and meet regulatory timelines (CMS,...Remote workHealth InsuranceContract workWork at office
- ...Sagility is seeking an Appeals and Grievance Coordinator who will manage and resolve member and provider complaints while adhering to regulatory requirements. This role involves conducting investigations, documenting actions, and ensuring compliance. As a key contact for...Remote workWork from home
$22 - $23 per hour
...Immediate need for a Grievance & Appeals Coordinator .... ...potential and is US ( Remote ). Please review... ...not limited to, health insurance (... ...vision), 401(k) plan, and paid sick leave... ...appeals and grievance cases in accordance... ...throughout the case management process Identify...Remote workHealth InsuranceContract workWork at officeLocal areaImmediate start$248.5k - $373k
...Appeals And Grievances Medical Director At UnitedHealthcare... ...simplifying the health care experience,... ...and grievances cases for... ...flexibility to work remotely from anywhere within... ...for various health plan and insurance products... ...Insurance/Department of Managed Healthcare, and...Remote workHealth InsuranceMinimum wageWork experience placementLocal areaWork from home- ...mission to inspire health and make it easy.... ...hybrid, onsite or remote. While the majority... ...acumen and managed care expertise related... ...member and provider appeals, grievances, reconsiderations... ...Authorization (PA), Claims, Case Management and/or... ...and benefit plan requirements to...Remote workHealth InsuranceFull timeContract workWork experience placementWork at officeLocal area1 day per week
$73.26k - $91.54k
...Quality Performance & Grievance and Appeals Location: Montebello,... ...leading key Quality Management activities that drive... ...Management, Population Health, and operational... ...) Retirement savings plans with employer matching... ...the background report. Remote Type: Hybrid About US...Remote workHealth InsuranceLocal areaFlexible hours$89.76k - $127.98k
...performing utilization management and concurrent review activities... ...verbal and written appeals related to denied... ...Utilization Review and Appeals Case Manager may include the... ..., treatment plans, laboratory results, and... ...Brook Medicine's Employee Health Services* Complete electronic...Health InsuranceFull timeWork at officeFlexible hoursWeekend workDay shiftWeekday work$89.76k - $127.98k
...Utilization Review and Appeals Case Manager Position Summary This position is responsible for... ...Review clinical documentation, treatment plans, laboratory results, and physician... ...clearance from Stony Brook Medicine's Employee Health Services ~ Complete electronic...Health InsuranceFull timeWork at officeFlexible hoursShift workWeekend workDay shiftWeekday work- ...Appeals Pharmacist – Ensure Fair Medication... ...A confidential managed care... ...coverage appeals and grievances. Apply evidence... ...guidelines, plan policies, and regulatory... ...during case reviews.... ...hybrid or fully remote options. Rewards... ...partner working with health plans and...Remote workHealth Insurance
- ...Group is seeking a Physician Assistant to join our Appeals and Grievances team. Under supervision by a Medical Director, you will adjudicate cases for UnitedHealthcare and related companies, supporting various health plans and products. You will collaborate with medical...Remote jobHealth Insurance
$50k - $55k
...direction of the Appeals Department leaders... ...analysis of appeals, grievances, and other types... ...Prepare and disseminate case file for External... ...Fair Hearing Manage and monitor all... ...personnel in resolving health plan requests or... ...interruptions Remote Work Requirements...Remote workHealth Insurance- ...do In this vital role the Case Manager will experience day to day... ...reimbursement issues (PAs, denials, appeals, reauthorizations,... ...Amgen offers a Total Rewards Plan comprising health and welfare plans for staff... ...Flexible work models, including remote work arrangements, where...Remote jobHealth InsuranceFlexible hours
- ...professional to support the administration of the Appeals and Grievance process. The role involves acting as a liaison between members and the Plan regarding denied claims, services, and other concerns. Responsibilities include managing member appeals, ensuring compliance with...Remote work
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- ...Pride Health is seeking a Grievances and Appeals Nurse for a remote contract position. This role is vital in investigating and resolving grievances and appeals efficiently for a well-known client. Responsibilities include acting as a subject matter expert, ensuring compliance...Remote workContract work
- ...Elevance Health is seeking a Grievance/Appeals Analyst I to review and process non-complex grievances and appeals in the Enterprise Grievance & Appeals Department. This entry-level position allows for virtual work but requires in-person training sessions. The ideal candidate...Remote work
- ...Appeal & Grievance Coordinator Reviewer I We are seeking an Appeal & Grievance Coordinator Reviewer I to review and research medical appeals... ...along with proficiency in Salesforce and GuidingCare for case management and documentation. Preferred Skills: Appeals & Grievances...Remote workWork at office
- ...PharmaCord LLC is seeking a Remote Patient Access Advocate to manage reimbursement inquiries and provide patient support. The ideal candidate will have... ...compliance protocols. This role offers comprehensive health plans and opportunities for advancement in a mission-driven...Remote workHealth Insurance
$30.72 per hour
...Grievance and Appeals Nurse (LVN) Position Type: Full-time Schedule: (... ...ensure grievance and appeal cases are processed per the Grievance... ...and Department of Managed Health Care (DMHC)/ Department of... ...required to ensure Health Plan operations and department business...Health InsuranceFull timeImmediate startWork from home- ...Working remotely, the full-time Reimbursement Case Manager will manage customer service and case management for patients, healthcare providers, and pharmacies... ...benefit investigations, prior authorizations, and appeals while providing exceptional customer service...Remote workHealth InsuranceFull time
- ...Job Title Job Description Process appeals and grievances, analyze, research, and provide comprehensive... ...and communicate disposition of case. Conduct pertinent research in order to... ...contract and regulatory provisions. This is a Remote Role Experience Experience handling a large...Remote workContract workApprenticeshipLocal area
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