Grievance and Appeals Coordinators
$30 - $32 per hourPyramid Consulting, Inc
Overview Immediate need for a talented Grievance and Appeals Coordinators . This is a 06+months contract opportunity with long-term potential and is located in Portland, CA(Hybrid) . Job ID: 25-81619 Base pay range: $30.00/hr - $32.00/hr Responsibilities Manage grievances and appeals processes, including investigations and coordination with internal and external stakeholders. Provide case management support and ensure timely and accurate handling of inquiries via phone and email. Collaborate on utilization management and contribute to member services activities. Engage in patient interactions and handle inbound/outbound calls as required. Qualifications A minimum of 2-5+ years of experience in Grievances and Appeals, with strong communication skills across phone and email channels. Prior experience in the healthcare industry is essential. Proven expertise in investigations, utilization management, and both internal and external member services. Able to work onsite for the first 2 weeks at least. Employment details Employment type: Contract Job function: Health Care Provider Industries: Hospitals and Health Care Notes Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, colour, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. You can reply STOP to cancel and HELP for help. You can access our privacy policy here. Get notified about new Appeals Coordinator jobs in California, United States. #J-18808-Ljbffr Pyramid Consulting, Inc
$19.43 - $32.98 per hour
...resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members. Key Details : This is a remote... ...files on individual appeals and grievances May coordinate the Grievance and Appeals Committee Support the...SuggestedHourly payFull timePart timeWork at officeRemote workFlexible hours- ...Standard Time hours. You will facilitate medical necessity grievances, appeals, and denials, review clinical data, and determine if criteria... ..., preparing case reviews for the Medical Director, coordinating with providers, and ensuring timely appeals. #J-18808-Ljbffr...SuggestedRemote job
- Blue Shield of California is seeking a Regulatory Complaint Coordinator, Intermediate, within the Appeals and Grievance Department to respond to inquiries from state regulatory agencies. The role reports to the Regulatory Complaint Supervisor and emphasizes timely, compliant...Suggested
- Commission on Medical Care in California is seeking a Grievance & Appeals Investigator to review, investigate, and resolve member grievance and appeal cases ranging from low to high complexity in Fairfield, Redding, Eureka, and Chico. You will transform member dissatisfaction...Suggested
$27.02 - $48.55 per hour
...Position Purpose: Facilitate medical necessity grievance, appeals and denials including disposition of denials notification letters, review of clinical information to determine if medical necessity criteria are met Key Details: Candidate must hold California RN Licensure...SuggestedHourly payFull timePart timeWork at officeRemote workFlexible hours- Job Overview Akkodis is partnering with a local Health Plan who is hiring a Grievance Coordinator for a temporary 3-month contract. Terms Temporary 3-month contract Remote (must pick up equipment) $28/hr W2 Qualifications 3+ years’ experience as a Service Representative...Temporary workLocal areaRemote work
$63.9k - $83.08k
...pivot from a “job” opportunity to anauthentic experience! The Grievance & Appeals Nurse is responsible for working directly with the IPAs,... ...Medicare and Medicaid Services (CMS) regulations and NCQA. Coordinate care of Members in conjunction with the Member’s PCP and...Remote jobTemporary workImmediate startFlexible hours- Centene Corp. is seeking a remote RN/LPN/LVN with 2+ years of clinical nursing experience to facilitate medical necessity grievances, appeals and denials. The role requires California licensure and PST hours. You will review clinical data, prepare case reviews for the Medical...Remote job
- Inland Empire Health Plan is hiring a Grievance & Appeals Nurse in California. The role focuses on processing grievances and appeals per regulatory standards, coordinating with IPAs, hospitals, and IEHP teams to ensure timely, quality member care. The position requires...Remote work
- Centene Corp. in California is seeking a remote nurse reviewer to facilitate medical necessity grievances, appeals, and denials. The role requires an active CA RN/LPN/LVN license and PST hours for remote work. You will review clinical data, overturn or uphold denials per...Remote job
- Centene Management Company LLC is seeking a nurse to facilitate medical necessity grievances, appeals and denials while reviewing clinical data to determine if criteria are met. The role requires California RN/LPN licensing and supports remote work with PST hours. Responsibilities...Remote job
$66.9k
...experience, our division provides campus-wide coordination and leadership of student success... ...among residential students, hears grievances and initiates mediation. 25% - Core Function... ...involving misconduct; or have filed an appeal of a finding of misconduct with a...Full timeContract workFor contractorsLive inShift workNight shiftAfternoon shift$21.73 - $30.43 per hour
...Regulatory Complaint Coordinator, Intermediate The Appeals and Grievance Department Regulatory team is responsible for responding to inquiries received directly from our state regulatory agencies. In this role you will be responsible for effectively managing your time...Full timePart timeWork at officeLocal areaWork from homeHome office2 days per week- General Manager Social, Golf - Leadership Talent Network General Manager Social, Golf - Leadership Talent Network General Manager Social, Golf - Leadership Talent Network General Manager Social, Golf - Leadership Talent Network Assistant General Manager Social/Golf Experience...Remote job
- A leading healthcare staffing firm is seeking a detail-oriented individual for managing medical necessity appeals and claims reviews. The role involves reviewing cases, preparing documentation for the Medical Director, and ensuring compliance with NCQA guidelines. Candidates...
- Turn clinical expertise into systemwide impact as a Coordinator Pharmacy Operations supporting high-quality pharmacy care across multiple... ...California, the Pharmacy Operations Coordinator can enjoy an appealing blend of professional opportunity, relaxed living, and easy access...Seasonal workLocal areaWeekend workDay shift
$57k - $65k
...continued economic development of the region. About The Job The Coordinator, Office of K-20 Regional Alliances, provides administrative,... ...proceeding involving misconduct; or have filed an appeal of a finding of misconduct with a previous employer. Equal Employment...Hourly payContract workWork at officeLocal areaWeekend workAfternoon shift$75 per hour
A digital reporting agency is seeking a Digital Court Reporter for in-person appeals hearings in Sacramento, California. The role requires capturing a digital record, monitoring audio quality, and maintaining a chain of custody for audio files. Candidates should have prior...Hourly payFull timeContract work$22.68 - $30.04 per hour
...Insurance Coordinator Primary Purpose: Under the supervision of the Clinic Manager, processes insurance claims and performs other related... ..., allegations, resignations under investigation, or appeals related to sexual harassment or misconduct within the past seven...Hourly payWork at office$27.07 - $34.52 per hour
...following SOP’s provided by the Clinic. Contacting clinical staff to coordinate peer to peer calls between Physicians and the health plan as... ...provide information to Insurance Follow Up Manager for claim appeals. All other duties as assigned including department‑specific...Hourly payWork at officeFlexible hours- ...the Team Position Summary: The Ambulatory Infection Prevention Coordinator 4 provides advanced infection prevention expertise across... ...disciplinary proceeding involving misconduct; or have filed an appeal of a finding of misconduct with a previous employer. The following...Work at office
$28.28 per hour
...of Medicare, Medi-Cal, PPO, HMO, and managed care authorization requirements and guidelines. Direct experience handling insurance appeals, complex claim resolutions, and denial management workflows. Familiarity with UCI Health operational workflows and Epic work queue...Temporary workPart timeWork experience placementWork at officeLocal areaMonday to FridayAfternoon shift- ...Angeles County through excellence in patient care, research and medical education. Your Role on the Team Position Summary The DRG Appeals Specialists will review and analyze denied/downgraded MS DRG and APR-DRG accounts received from payers (e.g. Medicare, Commercial and...Monday to Friday
- UCI Health is seeking a DRG Appeals Specialist to review denied/downgraded MS-DRG/APR-DRG accounts from payers and determine appealability. The role involves applying coding guidelines and preparing appeal letters while tracking denial root causes for documentation and...
- ...no patient interaction. This person will be reviewing cases to make sure the correct medical actions were taken and denying and appealing those cases. They will be writing letters and correspondence and sitting at a computer all day. Position Purpose: Facilitate medical...Private practiceWork at office
- ...professionals on our team that will embrace this important work!! We want people to join our team in the role of Tissue Recovery Coordinator with previous experience in tissue banking or the medical field. This position oversees the activities of the Tissue Team, ensuring...Temporary workLocal area
- ...PDS Health in Rancho Cordova, CA seeks a Healthcare Coordinator to partner with supported dentists and help patients commit to treatment. You will explain financial options, educate patients on choices, overcome objections, and keep schedules productive to support PPE...
$18 - $21 per hour
...excellence in hospitality and the culinary arts, and the flagship hotel for the Auberge Collection. Job Description The Part-Time Spa Coordinator schedules appointments, greets guests, escorts them to treatment areas, and provides information on spa services, treatments, and...Part timeLocal areaFlexible hoursShift work$68k
...operational capabilities to support customers across scientific, clinical, technological, and program management areas.The Prevention Coordinator will support the National Guard Bureau (NG), J1 Warrior Resiliency & Fitness (WRF) Substance Abuse Program (SAP), Suicide...For contractorsWork at office$24 - $28 per hour
...Front Office Coordinator Caton J. State, DDS - Greater Sacramento Proudly supported by Mosaic Dental Collective Caton J. State, DDS, part of the Mosaic Dental Collective, is looking for a friendly, organized, and people-focused Front Office Coordinator to join our team...Full timeMonday to Friday
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