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
$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- ...Geisinger is seeking a dedicated 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...Remote work
$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...Remote workHourly payFull timeContract workWork experience placementWork at office$45.9k - $78.6k
...quality service is the norm and every member feels valued. The Appeals & Grievances Specialist plays a vital role in ensuring fair, timely, and... ...with Microsoft Word, Excel, and Outlook This position is a Remote role.To be eligible for consideration, candidates must have...Remote workWork experience placement$60.78k
...Appeals and Grievances Specialist II Job Category: Customer Service Department: Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position... ...work after hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in hours/shift in critical...Remote workFull timeLocal areaShift workWeekend work- Banner Health seeks a remote Grievance & Appeals Coordinator in Arizona to support members and providers through the grievance, appeal, and claim-dispute process. This part-time role requires experience with AHCCCS, CMS regulations, and strong communication. You will manage...Remote jobPart timeMonday to FridayShift work
- 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, ensuring compliance with various health regulations, and preparing reports. Requirements include at least 2 years...Remote jobFull time
$70k - $80k
Piper Companies is seeking a Remote Clinical Appeals Analyst to provide clinical expertise in reviewing and resolving complex member and provider... ...must hold an active North Carolina licensure as an RN, LPN, PT, or OT and have significant clinical experience. The salary...Remote jobFull timeContract workMonday to Friday- Blue Cross Blue Shield of Arizona needs a clinical expert for managing member and provider appeals. This remote position requires strong accuracy, knowledge of compliance timelines, and a focus on customer service. Applicants should possess a healthcare-related degree...Remote job
$30.5 - $41 per hour
...Cardiovascular Medicine, PLLC is seeking a Registered Nurse (RN) or Licensed Practical Nurse (LPN) to join our Device Clinic team. If you have strong... ...limited patient assessments. Processing and scheduling remote device checks. Handle telephone triage of incoming...Remote workWork at officeLocal areaMonday to FridayWeekend work$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 workHourly payWork at office- ...claims reviews, CPT and ICD coding. Responsible for reviewing, classifying, researching and resolving member complaints (grievances and/or appeals) and communicating resolution to members or their authorized representatives in accordance with the standards and requirements...Full timeContract workFlexible hoursAfternoon shift
- ...Position Responsible for processing expedited appeals: those that are complex in nature,... ...times of the Expedited Appeal unit, the Specialists are required to work weekends and holidays... ...versed in all aspects of the complaint, grievance and appeal process and be able to...Remote workHourly payContract workWeekend work
- ...States is seeking a Denials Management Specialist to join our remote team. This role focuses on inpatient... ...denials, medical necessity reviews, and appeals for insurance payers. You will... ...candidates will have nursing experience, RN license, and 2-5 years in case/un utilization...Remote job
$28 - $35 per hour
...Job Description Appeals & Grievances Specialist II Location: Los Angeles CA 90017 Type: Full-Time/Contract Pay: $28 - $35 About the Role We're seeking an experienced Appeals & Grievances Specialist II to investigate, resolve, and manage member...Full timeContract workWork at office$37.1 - $55.65 per hour
...reimbursement for qualifying positions RN ($37.10-$55.65 based on experience):... ...regulatory or accrediting agencies. LPN ($25.22-$37.83 based on experience): A... ...months of hire. FTE: 0.3 Possible Remote/Hybrid Option: Shift Rotation: Night...Remote workPart timeLocal areaRelocationFlexible hoursShift workNight shiftWeekend work- ...Looking for qualified Unit Manager (RN or LPN) to join our team! Location: Newport News Nursing... ...Work with families and staff to address grievances and maintain resident rights. Assist in... ...adults. From telemedicine services and remote health monitoring to advanced diagnostic...Remote workFull timeLocal areaShift work
- NeighborHealth’s SCO RN UM Reviewer role is based in East Boston within the Senior Care Options team. You will review clinical appeals and service authorization needs to ensure medical necessity aligns with CMS standards and organizational determinations. The role requires...Remote job
- Appeals & Grievance Specialist Schedule Monday - Friday Onsite Position Position Summary The Appeals & Grievance Specialist II is responsible for independently researching, reviewing, and resolving member and provider inquiries, complaints, appeals, and grievances....Work at officeMonday to Friday
$248.5k - $373k
.... Growing together.Work at home!You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities:The Appeals and Grievances Medical Director is responsible for ongoing clinical review and adjudication...Remote workMinimum wageWork experience placementLocal areaWork from home- ...Managing member appeal cases remotely, the contract Member Appeals Specialist will ensure accuracy, compliance, and timely resolution while coordinating incoming appeals and collaborating with cross-functional teams in a highly regulated healthcare environment. Key responsibilities...Remote workContract work
- A healthcare staffing company is seeking a Remote Registered Nurse (RN) to specialize in triage on a PRN basis. Ideal candidates will have at least 1 year of nursing experience and an active RN license. Responsibilities include conducting patient assessments, providing...Remote workPart timeReliefWork from home
- ...Looking for qualified Wound Care Nurse (RN or LPN) to join our team! Location: Hilltop Job... ...as the primary contact between the Wound Specialist Physician and the nursing team, ensuring... ...adults. From telemedicine services and remote health monitoring to advanced diagnostic...Remote workLocal areaShift workNight shiftWeekend workDay shiftAfternoon shift
- ...Working remotely in a full-time capacity, the Appeals Specialist will leverage expertise in claims adjudication and risk management to guide clients through the appeals process, ensuring compliance and effective communication with stakeholders. Key responsibilities Reviews...Remote workFull timeContract work
- ...Denials Specialist Insight Global is seeking a fully remote Denials Specialist to support a Healthcare AI client. This is a part-time opportunity working approximately... ...where candidates will leverage their denials and appeals expertise to evaluate and improve AI-driven denial...Remote workContract workPart timeMonday to FridayFlexible hoursShift workWeekend work
- ...Appeals Specialist We are seeking a detail-oriented and experienced Appeals Specialist for our client in Middleburg Heights, Ohio. In this... ...$19.50-$21.00 Monday-Friday 8am-5pm 3 months in office then remote Benefits offered Key responsibilities include reviewing assigned...Remote workWork at officeMonday to Friday
- ...Detail-oriented and analytical, the remote Billing & Appeals Specialist will manage provider billing disputes and appeals, ensuring accurate resolutions while maintaining exceptional customer service in a contract role. Key responsibilities Review, investigate, and resolve...Remote workContract workWork at office
- Find your calling at Mercy! Position Details: Primary Care Nurse RN or LPN Mercy Clinic Quailbrook (Oklahoma City) Monday-Friday, 40 hours per week *This is a hybrid remote position. The person hired for this role will complete at least 90 days of full-time...Remote workFull timeMonday to Friday2 days per week3 days per week
- ...is seeking a Clinical Quality Assurance Coordinator for a fully remote position. In this role, you will ensure top-quality peer review... ...regulatory standards. The ideal candidate will be an active RN or LPN with strong clinical skills and a commitment to maintaining the...Remote workWork from home
$83.1k - $120.36k
...Position Summary: The Appeals & Grievances (A&G) unit manages Healthfirst member... ...manner. The A&G Clinical Specialist is the subject matter expert... ...providers. This is either a remote or on-site position located... ...assigned Minimum Qualifications RN Preferred Qualifications...Remote workContract workTemporary workWork experience placementLocal area
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