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
- ...skilled professional for a clinical role addressing provider appeals and grievances. This position demands expertise in managed care while ensuring... ...ideal candidate will possess a relevant degree, an active RN license, and several years of experience in healthcare, particularly...Remote job
$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- ...positions are classified as hybrid, onsite or remote. While the majority of our employees are... ...to requests for member and provider appeals, grievances, reconsiderations and corrected claims... ...a compact state as a Registered Nurse (RN) Required Certifications ~...Remote workFull timeContract workWork experience placementWork at officeLocal area1 day per week
- ...Elevance Health is seeking a Grievance/Appeals Representative I to work virtually full-time, handling grievances and appeals related to service and benefit coverage issues. The representative will conduct investigations, communicate with customers, and generate written...Remote workFull time
- ...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
- ...Elevance Health in Tampa, Florida seeks a Grievance/Appeals Representative I to manage customer claims and ensure resolution of grievances. This role primarily involves analyzing and processing claims, with a significant focus on communication and documentation. The ideal...Remote workFlexible hours
- ...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 workFull time
$60.78k
...Appeals And Grievances Specialist II Job Category: Customer Service Department: CSC 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$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$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 workFull timeContract workMonday to Friday- Western Health Advantage, Inc. is seeking an Appeals & Grievances Nurse (RN) for a hybrid role based in Sacramento, CA. The nurse will join the Utilization Management team and play a critical role in ensuring regulatory compliance and member support through the appeal...
- Geisinger is looking for a professional to provide support in the administration of the Appeals and Grievance process. This role involves liaising between members and the plan to address denied claims and benefit issues. Applicants should have a minimum of 5 years of relevant...Remote job
$95k - $115k
Western Health Advantage seeks an Appeals & Grievances Nurse (RN) for their Utilization Management team in Sacramento, CA. This full-time role offers a salary between $95,000 and $115,000 annually. The nurse will collaborate with various stakeholders to ensure compliance...Full time- Firstsource Solutions Limited is seeking a full-time hourly Remote Customer Service Representative in the United States. The role involves reviewing grievance and appeals documents, classifying disputes, and managing member information in line with HIPAA regulations. The...Remote jobHourly payFull time
- L.A. Care Health Plan is seeking an Appeals and Grievances Nurse Specialist RN II to assist members with health care access and benefit coordination issues... ...and a nursing degree. This position offers a hybrid remote schedule and includes various benefits such as Paid Time...Remote job
$35 - $63 per hour
...experienced healthcare coder to analyze DRG Appeals, prepare written appeals, and collaborate... ...team. The role requires an unrestricted RN license and extensive knowledge of ICD-10... ...judgment. Enjoy the flexibility to work remotely from anywhere in the U.S., with specific...Remote jobHourly payWork at officeLocal area$38.17 - $57.25 per hour
Elevance Health is seeking a Nurse Appeals RN to work virtually full-time, with in-person training required. The role involves investigating medical necessity appeals requests and requires a high school diploma and 2+ years of managed care healthcare experience. Candidates...Remote jobFull time- The Elevance Health Companies, Inc. is seeking a Nurse Appeals-RN to manage medical necessity appeal requests. The position allows for virtual work full-time with in-person training required. Successful candidates will investigate appeals, review medical records, and provide...Remote jobFull time
$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$88.85k
...Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID: 13049... ...requires work after hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in hours/shift in...Remote workFull timeShift workWeekend work- Hill Valley Healthcare Corporate is seeking an experienced ADR Specialist (RN or LPN) to support our Skilled Nursing Facilities. This is a 100% remote position, ideal for MDS experts looking to ensure regulatory compliance and optimize reimbursement accuracy across multiple...Remote job
$102.18k
...Lead Customer Solution Center Appeals and Grievances RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA... ...requires work after hours, on weekends, holidays, a hybrid remote schedule, and occasional flexibility in hours/shift in critical...Remote workFull timeShift workWeekend work$71.59k - $116.48k
...healthcare organization is seeking an A&G Clinical Specialist to manage health member complaints and appeals. This fully remote position requires expertise in clinical case... .... The ideal candidate should be an RN, LPN or Dental Hygienist with experience in appeals...Remote job- 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
- ...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...Remote workFull timeMonday to Friday2 days per week3 days per week
- ...Member And Provider Complaint Resolution Specialist 100% remote candidates must live in one of the preferred 15 states (AZ, FL, GA... ...for the comprehensive research and resolution of the appeals, dispute, grievances, and/or complaints from Molina members, providers and...Remote workContract workLive inMonday to Friday
- ...Find your calling at Mercy! Position Details: Primary Care Nurse RN or LPN Mercy Clinic Primary Care - Edmond Santa Fe 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...Remote workFull timeMonday to Friday2 days per week3 days per week
- ...RN/LPN - Weekends Looking for qualified Weekend Nurse (RN or LPN) to join our team!... ...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
$77.91k - $116.86k
...not only changing lives but saving them. Together. The Clinical Appeals Nurse is responsible for reviewing requests for appeals of both... ...Determinations) Education: • Required: Completion of an accredited LVN or RN nursing program • Preferred: Associates or Bachelor's degree in...Remote workFull timeLocal area$50k - $55k
...Appeals Coordinator Level II At MedReview, our mission is to bring... ...the department. The Appeals Specialist level II performs research,... ...investigation, and analysis of appeals, grievances, and other types of... ...frequent interruptions Remote Work Requirements: High speed...Remote work
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