Appeals & Grievances Case Manager (Oregon)
$27 - $30 per hourTemporary
Pyramid Consulting, Inc.
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.
- 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
Required Experience:
Manager
]]><Vacancy posted 6 days ago
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