Remote Appeals & Grievances Specialist (RN/LPN/DH)
Healthfirst
- Remote job
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 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...Remote work
$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- ...Hospital system looking to bring on RN Manager Grievances & Appeals! Sign On Bonus and Relocation! Ready to make your application Please do read... ...(CCM) or CCM certification within 1 Year Required Remote working/work at home options are available for this role....Remote workWork from homeRelocationRelocation package
- ...Healthfirst is seeking a Grievance Specialist to join its Appeals & Grievances team in a fully remote position. You will manage and resolve member complaints across Medicare, Medicaid, and other Healthfirst programs, coordinating with internal teams and external partners...Remote work
- ...Workday is seeking a Grievance & Appeal Specialist to address appeals within required timeframes and ensure contractual obligations are met. The... ...Procedures to ensure compliance with regulatory standards. This remote position requires strong communication, confidentiality,...Remote work
- ...Managing the resolution process for medical and pharmacy member appeals and grievances, the full-time remote Appeals and Grievance Specialist will ensure compliance with regulatory requirements and accreditation standards while coordinating with internal and external stakeholders...Remote workFull time
$60.78k
...Appeals and Grievances Specialist II Job Category: Customer Service Department: Appeals & Grievances Location: Los Angeles, CA, US, 900... ...requires work after hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in hours/shift in...Remote workFull timeLocal areaShift workWeekend work- Point32Health, Inc. is seeking an Appeals and Grievance Coordinator to manage day-to-day tasks within the A&G department. You will process mail, assign cases, and support analysts while ensuring compliance with regulatory timelines. The role requires 1-2 years of relevant...Remote jobWork from home
- Elevance Health in California is seeking an entry-level Analyst in the Enterprise Grievance & Appeals Department to review, analyze and process non-complex grievances and appeals across multiple product types, including HMO, PPO, POS, and others. You will work under guidance...Remote job
$21.16 - $38.37 per hour
Join to apply for the Medicare Appeals & Grievances Specialist (PST Hours) role at Molina Healthcare . This position is remote and will be working Pacific Standard hours. Highly Qualified Candidates Will Have The Following Experience Strong understanding of UM, Appeals...Remote workHourly payFull timeContract workWork experience placementWork at office$20 - $21 per hour
...greater-NYC), OH, SC, TX, UT, WA (outside greater-Seattle), WI Responsibilities: Research & resolve member/provider appeals, grievances, and complaints. Review claims, benefits, records & contracts; prepare timely resolutions and correspondence. Qualifications...Remote jobTemporary work$59 - $60 per hour
WE’RE HIRING: REMOTE REGISTERED NURSE (RN) 100% REMOTE | MONDAY-FRIDAY | $59-$60/HR We are looking for experienced Registered Nurses for a... ...Utilization Management experience Prior Authorization experience Grievance & Appeals experience preferred, but not required #J-18808-Ljbffr...Remote workMonday to Friday- Panacea Health is seeking a Centralized Intake Specialist for Saturdays and Sundays, 8am-8pm, with remote work available to residents of Pennsylvania. You will... ...and initiate intake with care. The role requires RN or LPN licensure in PA, experience with admission coordination...Remote jobWeekend work
$102.18k
...Lead Appeals And Grievances RN Salary Range: $102,183.00 (Min.) - $163,492.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent... ...requires work after hours, on weekends, holidays, a hybrid remote schedule, and occasional flexibility in hours/shift in...Remote workShift workWeekend work$26.99 per hour
We are currently seeking experienced Appeals & Grievances Specialists! This is a full remote opportunity paying $27/hr. The ideal candidate has experience investigating and responding in writing to internal and regulatory complaints. Experience in ACA is a plus. If...Remote workHourly payPermanent employmentTemporary workWork experience placementShift work- ...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 jobHourly payWork at office- ...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...
- Humana Inc. is seeking a Grievances & Appeals Representative 3 to handle expedited Medicaid and AIP (dual) appeals, reviewing clinical documentation... ...report to the Grievances & Appeals Supervisor and work in a remote setup with possible travel for training or meetings.J-18808-...Remote job
- ...Looking for qualified Weekend Nurse (RN or LPN) to join our team! Location: Arden Ridge... ...concerns from residents and families, ensuring grievances are handled professionally and... ...adults. From telemedicine services and remote health monitoring to advanced diagnostic...Remote workFull timeLocal areaShift workNight shiftWeekend workDay shiftAfternoon shift
- ...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
- MJHS in New York, NY seeks an A&G Coordinator to investigate and respond to member and provider appeals and grievances under CMS and DOH rules. In a non-clinical role, you will help ensure timely decisions and accurate documentation. You will determine the appropriate...
- L.A. Care Health Plan in Los Angeles, CA is seeking an Appeals and Grievances Specialist II to receive, investigate, and resolve member and provider complaints and appeals. The role ensures compliance with CMS, DHCS, DMHC, MBMIB and NCQA standards while handling complex...
$48.5k - $70.5k
...year history of providing health insurance that works for our members, no matter their circumstances. Job Summary The Appeals and Grievance Specialist is responsible for managing the resolution process of medical and pharmacy member appeals and/or member generated...Contract workWork at officeFlexible hours$22 - $25 per hour
...communities." Western Health Advantage Western Health Advantage (WHA) is seeking a detail-oriented and customer-focused Appeals & Grievances Specialist to join our team. In this fast-paced role, you will support members by managing appeals and grievances while ensuring...Hourly payWork experience placement- A healthcare service company is seeking a G&A Coordinator in Detroit, MI. This role involves processing appeals, grievances, and inquiries from members, requiring strong analytical and communication skills. The ideal candidate will have a bachelor's degree and experience...
$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$28 - $35 per hour
...Location: Remote (U.S.) Preferred Location: Candidates based in or near Beachwood, OH are strongly preferred. Reports To:... ...Madison Industries, on a direct hire opportunity for a Denials & Appeals Specialist. This is a remote revenue cycle role focused on...Remote workHourly payWork at officeLocal area- ...Researching and responding to inquiries from various stakeholders, the full-time Appeals Specialist will manage the appeals/dispute process remotely, ensuring timely and accurate customer service and resolution of issues. Key responsibilities Provides customer service...Remote workFull timeContract workFor contractorsWork at office
$32.13 - $48.2 per hour
...Registered Nurse (RN) The Registered Nurse (RN) will utilize the nursing process of... ...physician etc) · Provides oversight of LPN assessments (as assigned) and co-signs nursing... ...language skills, written and verbal Remote Type: On-site Salary Range: $32.13 - $4...Remote workFlexible hoursShift work
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