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$81.1k - $116.48k
Position Summary: The Appeals & Grievances (A&G) unit manages Healthfirst member... ...manner. The A&G Clinical Specialist is the subject matter... ...providers. This position is 100% Remote. We are hiring for the... ...Minimum Qualifications: RN, LPN OR Dental Hygienist Preferred...Remote jobContract workTemporary workWork experience placementLocal areaMonday to FridayShift work- UnitedHealthcare offers a remote-friendly physician assistant role across the United States, focusing on review and adjudication of appeals and grievances. You will collaborate with medical directors and an integrated team to assess medical necessity and benefit design...Remote jobWeekday work
$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$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- Providence California Regional Services is seeking a Care Manager RN for a remote, full-time role. The position involves day shifts and focuses on coordinating clinically-based appeals and reimbursement processes for patients across PH&S California regions. Candidate must...Remote jobFull timeDay shift
- ...positively change healthcare! This is a remote position ESSENTIAL DUTIES AND RESPONSIBILITIES... ...Team Member. Job Description: The DRG Appeals Specialist performs reviews of inpatient DRG payer... ...writing. Required Education/Experience RN/RHIA/RHIT required. CCS will be required...Remote workTemporary workWork at officeLocal areaImmediate startShift work
$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- CorroHealth is seeking a DRG Appeals Specialist to perform reviews of inpatient DRG payer denials for hospital clients. You will validate ICD... ...methodologies, and coding guidelines to maximize appropriate reimbursements. This is a remote position. #J-18808-Ljbffr CorroHealth IncRemote job
$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- Ampcus Inc. is seeking a Utilization Management Specialist (Remote) to review medical necessity and authorization for clinical services. The role emphasizes clinical nursing expertise, care management experience, and adherence to guidelines and policies. The position requires...Remote job
$14.9 - $29.06 per hour
...(CMS). Essential Job Duties Enters denials and requests for appeals into information system and prepares documentation for further... ...language for letters and prepares responses to member appeals and grievances. Elevates appropriate appeals to the next level for review....Hourly payWork experience placementWork at office- Our client is seeking an experienced Grievance and Appeals Specialist with strong health plan industry experience to join their team. The Grievance and Appeals Specialist is responsible for reviewing, investigating, and resolving member and provider grievances and appeals...
$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- ...Grievance & Appeals Coordinator Are you an analytical problem solver with a passion for healthcare managed care? We are seeking dedicated... ...Coordinators to join our growing, collaborative team! In this fully remote role, you will analyze and resolve complex member and...Remote workWork from homeHome officeWeekend work
- ...General Brigham Health Plan is seeking an Appeals Coordinator to coordinate, process,... ...and ensuring regulatory compliance in a remote environment within the United States. Ideal... ...will have 3-5 years in health plan appeals/grievances, strong customer service, and excellent...Remote job
- ...Grievance & Appeals Coordinator Are you a detail-oriented managed care professional looking for an exciting work-from-home opportunity in Iowa? We are seeking a self-motivated, organized Grievance & Appeals Coordinator to join our dynamic team! In this essential role...Remote workWork from home
- ...Appeals and Grievance Specialist II (Managed Care) – Irving, TX | 12-Week Contract Location: Irving, TX Job Type: 12-Week Contract Company: Sigma Inc. Schedule: Monday–Friday | 8-Hour Shifts Join Our Team as an Appeals and Grievance Specialist II! Sigma Inc....Contract workMonday to FridayShift work
- Apolis is seeking a Grievance and Appeals RN in Phoenix, AZ (or remote within AZ time zone) to review and investigate member and provider grievances and appeals... ...requires an active Arizona nursing license (RN or LPN), a healthcare degree, and at least 5 years in grievances...Remote job
- Healthfirst is seeking an A&G Clinical Specialist to lead the development and resolution of clinical cases for member and provider appeals, ensuring compliance with applicable laws and internal policies. The role can be remote or on-site at the NYC or Lake Mary locations...Remote work
- MJHS seeks an A&G Specialist in New York, NY to handle department correspondence, log and route mail, and provide back-up support... ...and the director. The role emphasizes timely processing of grievances and appeals within regulatory timeframes. Responsibilities include opening...
- SafeRide Health in San Antonio, TX seeks an experienced Complaints and Grievance Coordinator to process member grievances, appeals, and provider disputes in alignment with client requirements across lines of business. You will document cases, maintain timelines, communicate...
- ...Looking for qualified Unit Manager (RN or LPN) to join our team! Location: Woodstock Valley... ...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
- UnitedHealth Group, through OptumCare, seeks a qualified professional to manage Medicare reconsiderations, grievances, and appeals, coordinating with CMS and internal stakeholders. You will help ensure CMS regulatory compliance and drive timely resolutions. The role requires...
$23.63 - $33.09 per hour
Our Grievance & Appeals Specialist I act as the primary investigator for member appeals and grievances including analyzing, researching, and managing inventories. Responding to member/provider requests within regulatory requirements and plan policy. We're looking for Grievance...Contract workTemporary workLocal area- 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
- ...Nursing Supervisor (RN or LPN)Location: Jamestown Health and RehabilitationJob Type: Full... ...concerns from residents and families, ensuring grievances are handled professionally and... ...adults. From telemedicine services and remote health monitoring to advanced diagnostic...Remote workLocal areaShift workNight shiftWeekend workDay shiftAfternoon shift
- ...UT Southwestern Medical Center in Dallas, TX, seeks a Technical Denials Management Specialist II to review, research, and resolve claim denials and appeals for various insurers, maximizing collections. The role emphasizes follow-up and resolution of denied claims with...Remote work
- ...calling at Mercy! The Cardiac Device Specialist (CDS) assists physicians, advanced practitioners... ...the CDS manages patient diagnostics via remote monitoring websites, analyzes... ...The ideal candidate will be an experienced RN with strong clinical judgment, exceptional...Remote workFull time
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