Remote Grievances RN - Clinical Appeals & Quality
UnitedHealth Group
- Remote job
UnitedHealth Group is seeking a Clinical Grievances Nurse to review retrospective cases and current cases ensuring appropriate care and addressing immediate member needs. This role offers PST hours with remote work options and a Monday–Friday schedule. You will perform clinical assessments, consult Medical Directors, document case chronology, and communicate with providers to obtain needed information while upholding UHG values. #J-18808-Ljbffr UnitedHealth Group
- ...Phaxis is looking for a dedicated Remote RN Grievance and Appeals Specialist in Manhattan where your contributions... ...impact on patient care and overall clinic operations. We are looking for a... ...Review Entities). Track Quality Trends: Identify recurring claim denial...Remote workQualityPermanent employmentContract workTemporary workMonday to Friday
$28.94 - $51.63 per hour
...Growing together. Job Description - Clinical Appeals RN - Remote - M-F working alternating Saturdays (... ...communities and removing barriers to quality care. The work you do here impacts the... ...expertise in clinical appeals and grievances (analyzing, reviewing, and evaluating...Remote jobQualityHourly payMinimum wageFull timeWork experience placementWork at officeLocal areaMonday to FridayWeekday work$29 - $52 per hour
...removing barriers to quality care. The work you do... ...Growing together As a Clinical Grievances Nurse, you will be responsible... ...flexibility to work remotely* as you take on some... ...Current, unrestricted RN license in the state... ...experience Clinical appeals and grievances experience...Remote jobQualityHourly payMinimum wageFull timeWork experience placementLive inLocal areaImmediate startMonday to Friday- Medica is a nonprofit health plan serving diverse communities with a mission to provide coordinated, quality care. The Appeals and Grievances Clinical Specialist III role focuses on reviewing, investigating, and resolving member and provider appeals with clinical expertise...Remote jobQuality
$40 - $46 per hour
...is immediately hiring for a RN Clinical Appeals Specialist Position type:... ...: Philadelphia PA 19103 (Remote) As a RN Clinical Appeals... ...opportunities for process improvement quality improvement provider... ...management clinical appeals grievance and appeals operations or related...Remote workQualityHourly payFull timeContract workTemporary workFor contractorsWork experience placementWork at officeImmediate startWorldwideFlexible hours$83.1k - $120.36k
...Appeals & Grievances Clinical Specialist The Appeals & Grievances (A&G) unit manages... .... This is either a remote or on-site position located... ...measures productivity and quality for each Specialist against... ...Minimum Qualifications: ~ RN, LPN, & Dental Hygienist...Remote workQualityContract workTemporary workWork experience placementLocal area$25 - $35 per hour
...Companies is seeking a Clinical Appeals Nurse to join a... ...organization for a contract remote opportunity located in... ...Registered Nurse (RN) license in the State... ...of healthcare appeals, grievance processes, utilization... ...regulatory compliance, quality improvement, benefit determinations...Remote workQualityHourly payContract 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$29 - $52 per hour
About This Role As a Clinical Grievances Nurse, you will review incoming retrospective... ...hours and are looking for a remote opportunity. Highlights Pay :... .../or members Provide timely, quality service to members and... ...metrics Requirements Education RN license in the state of...Remote jobQualityFull timeLive inImmediate startDay shift$70.2k - $120.4k
...connected care, where coordinated, quality service is the norm and... ...member feels valued. The Appeals and Grievances Clinical Specialist III position is... ...Active, unrestricted RN license required 5+ years of... ...applications. This position is a Remote role.To be eligible for...Remote workQualityWork experience placementWork at office- 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
- ...Advantage HMO health insurer seeking a Nurse leader to manage Appeals & Grievances with clinical leadership and regulatory compliance. The role emphasizes... ...and strong reporting capabilities. The position is remote in the US with minimal travel; requires an LPN license and...Remote work
- Health Care Service Corporation (HCSC) is seeking an RN to facilitate member and provider appeals. The role collaborates with Medical Directors and Customer Service to ensure adherence to guidelines and audit standards, while managing inventory through structured workflow...Remote jobQuality
- ...HCSC) seeks a registered nurse to facilitate member and provider appeals, coordinating with Medical Directors and Customer Service to... ...managing inventory through established workflows. The position is remote with work hours 9 AM-5:30 PM CST, offering a competitive pay...Remote jobQuality
- 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
$69.8k - $125.9k
HCSC is seeking a dedicated RN to facilitate member and provider appeals, coordinating with Medical Directors and Customer Service to ensure compliant processes... ...and a solid foundation in healthcare operations. This remote position supports the U.S. market. Compensation ranges...Remote jobQuality- ...Clinical Appeals Nurse (RN) Status: Exempt Location: Remote Department: Clinical Appeals Reports To: Director of Clinical Appeals Position Overview... ...Appeal overturn rate and recovery contribution Quality and clarity of appeal documentation Timeliness...Remote workQuality
- ...are searching for a new RN to join our team. Our... ...flexibility to work remotely and do not have face-to... ...skills in addition to clinical experience. Upon receipt... ...by the Bookkeeper. Quality review rough draft... ...preferably in the capacity of Appeals/Grievances, Case Management,...Remote jobQualityHome officeMonday to FridayWeekend work
- ...Job Description LTSS Appeals Nurse (Remote) We are seeking a... ...perform high-volume clinical reviews within the appeals... ...Support departmental quality and process-... ...Registered Nurse (NY RN) license. Residency... ...utilization review, appeals, grievances, or clinical...Remote jobQualityLocal areaMonday to FridayFlexible hoursShift work
- UnitedHealth Group is seeking a Clinical Appeals RN to provide expert analysis of appeals and grievances, acting as a clinical interface liaison with facilities, providers... ...confidentiality adherence. The position offers remote work from anywhere in the U.S., with an M-F...Remote job
- ...is seeking a Medical Director to lead appeals and grievances review for UnitedHealthcare. This role... ...HMO, MAPD, and PDP products, applying clinical criteria and regulatory requirements.... ...of clinical practice and 2+ years in quality management, strong telephonic communication...Remote jobQuality
- ...Job Title: Clinical Quality Reviewer RN (Quality of Care Review) Duration: 12... ...Conversion to FTE) Location: Remote - California Candidates... ...PQIs) arising from member grievances, provider concerns, and internal... .... Collaborate with Appeals & Grievances teams and...Remote workQualityWork experience placementWork at officeMonday to Friday
- UnitedHealthcare is hiring a Clinical Appeals RN for remote work Monday-Friday, with alternating Saturdays. The role analyzes appeals and grievances, acts as a clinical liaison, and supports resolution with facilities, providers, and plans. We offer a flexible schedule,...Remote jobHourly payWork at officeMonday to FridayFlexible hours
$45.9k - $78.6k
...connected care, where coordinated, quality service is the norm and... ...feels valued. The Appeals & Grievances Specialist III role manages... ...proficiency in administrative, clinical, and regulatory processes to... ...This position is a Remote role. To be eligible for consideration...Remote workQualityWork experience placement- ...Clinical Coordinator Under the general direction of... ...to inquiries related to appeals following clinical determinations... ...improvement and quality assurance activities.... ...experience required OR RN licensed to practice in... ...team of clinicians Remote/desk work with- some statewide...Remote workQualityWork experience placementWork at office
$102.61k - $197k
...Manager of Appeals Complaints and Grievances Responsible for day to day oversight and management of Intake Clinical Appeals Claims Appeals Complaints Grievances... ...while enhancing quality and effectiveness. Additionally... ...and Certifications RN - Registered Nurse - State...Quality2 days per week$123.37k - $161.93k
...hiring an Associate Director, Appeals & Grievances to join our team. Oscar... ...operational oversight for Oscar's non-clinical Administrative CGA and Elite... ...Work Location: This is a remote position, open to candidates... ...for compliance and quality metrics across all lines of...Remote workQualityFull timeWork from homeHome office$29 - $52 per hour
...improving risk management, quality and revenue growth. Ready to... .... Growing together. The Clinical Claim Review RN will be responsible for performing... ..., the Auditor will support appeal and fraud investigation... ...schedule. This position is Remote in Massachusetts. You will...Remote workQualityHourly payMinimum wageFull timeContract workWork experience placementLive inLocal areaMonday to FridayShift 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- UnitedHealth Group is seeking a Remote Appeals Clinician in Texas. You will conduct comprehensive reviews... ...), evaluate records, and provide independent clinical judgments on medical necessity. Requirements include a Texas RN license and 2+ years in Medicaid with data-entry...Remote jobFlexible hours
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