Remote Grievances & Appeals Nurse — CMS-Centric
The Fountain Group
- Remote job
The Fountain Group is hiring Grievance & Appeals Nurses for a prominent healthcare client. This is a fully remote, 6-month contract opportunity with a pay rate of $35.39–$45.39/hour. 40 hours per week; must be able to support Arizona business hours. Openings: 2. Location: Fully Remote. The ideal candidate will hold an active RN or LPN license in Arizona or a Compact Nursing Multistate License, with 5+ years in CMS-related duties and a strong understanding of Medicare requirements. #J-18808-Ljbffr The Fountain Group
- Sentara Health is seeking a Director of Appeals and Grievance to plan, develop, and direct department services for existing and new business... ...and regulations, and manage audits (NCQA, EQRO, CMS, DMAS, BOI). Remote.US remote work supported. #J-18808-Ljbffr Sentara HealthRemote jobCms
- Overview Job Title: Registered Nurse - Claims & Appeals Review Location: Remote (Anywhere in Florida) Duration: 06 Months... .... Ensure compliance with NCQA, CMS, and state regulations.... ...+ years of experience in appeals, grievance, or quality assurance in a healthcare...Remote workCmsContract workDay shift
$248.5k - $373k
...home!You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you... .... Primary Responsibilities:The Appeals and Grievances Medical Director is responsible for ongoing... .../Department of Managed Healthcare, and CMS regulatory responses.Communicate with UnitedHealthcare...Remote workCmsMinimum wageWork experience placementLocal areaWork from home- Overview The Director of Appeals and Grievance will plan, develop, and direct the department services... ...of Appeals and Grievance: NCQA, EQRO, CMS, DMAS and BOI. Responsible to meet department... ...Bachelor\'s Degree (Required) Location Remote Experience Minimum five years of...Remote workCms
$30.72 per hour
Grievance and Appeals Nurse-LVN 25-00372 Base pay range $30.72/hr - $30.72/hr Position Type: Full time Schedule: (Hybrid) M-F, 8:00 am - 5 pm; Mon... ...Services (DHCS)/ Center for Medicare and Medicaid Services (CMS) regulations. This position coordinates member care in...CmsFull timeWork at officeLocal areaWork from home$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... ...knowledge Strong understanding of CMS regulations, Medicare MMP regulations and...Remote workCmsHourly payFull timeContract workWork experience placementWork at office$60.78k
...Appeals and Grievances Specialist II Job Category: Customer Service Department: Appeals & Grievances... ...for Medicare and Medicaid Services (CMS), California Department of Health Care... ...hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in hours...Remote workCmsFull timeLocal areaShift workWeekend work- WPS Health Solutions in Columbus, OH, is seeking an Appeals Nurse to review medical records and Medicare claims for first-level appeals to determine... ..., document clinical rationales, and ensure compliance with CMS guidelines. A registered nurse with strong communication and...Remote jobCms
- Solü Technology Partners in Phoenix, AZ seeks a Med Appeals & Grievance Specialist Coordinator to lead clinical and administrative CMS grievance/appeal workstreams for Part C and Part D. You will investigate member, provider and claims issues, ensure timely investigations...Cms
$11.41 per hour
...Description Role Snapshot The Appeals Nurse examines medical records and claims information... .... Work Location We are open to remote work in the following approved states:... ...clinical decision, are responded to within CMS quality and timelines standards....Remote workCmsHourly payFull timeContract workFor contractorsLocal areaImmediate startShift work- ...Appeals Processor III - RN ~ salary ~ Unavailable ~ Hours per week ~40 ~ Shifts... ...APP III) to join our dedicated team in a remote capacity. The Appeals Processor III (APP... ...compliance with federal/state regulations, CMS guidelines, and contract requirements....Remote workCmsContract workFor contractorsFor subcontractorShift work
- 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
- ...Member Appeals Specialist Primary responsibilities would include triaging incoming appeals/grievances, categorizing them appropriately, assigning them to the team, making outbound... ...(Specialists, Supervisor, Quality Nurses, Medical Directors, Pharmacy Team) Drafting...Remote workCmsTraineeship
- ...Investigating and responding to medical, pharmacy, and dental grievances, the full-time remote Appeal Coordinator I will manage complaints, appeals, and... ...processing or customer service preferred Knowledge of CMS rules for Medicare and Medicaid grievance, complaint, and...Remote workCmsFull time
- ...Connecting. Growing together Work at home! The Appeals and Grievances Medical Director is responsible for... .... You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you... .../Department of Managed Healthcare, and CMS regulatory responses Communicate with...Remote jobCmsWork from home
$60.2k - $107.4k
...with the Director of Nursing and Agency Management... ...Possibility to go hybrid or remote in future.Job Function... ...(e.g., OSHA, HIPAA, CMS, vendor compliance,... ...procedures, case management, appeals and grievance procedures)Demonstrate... ...member/customer centric approach to workIdentify...Remote workCmsMinimum wageFull timeWork experience placementWork at officeLocal areaMonday to Friday$248.5k - $373k
...Connecting. Growing togetherWork at home!The Appeals and Grievances Medical Director is responsible for... ....You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you... .../Department of Managed Healthcare, and CMS regulatory responsesCommunicate with UnitedHealthcare...Remote workCmsMinimum wageWork experience placementLocal area- ...Careers is seeking a GAU Case Specialist in Providence to investigate, manage, and resolve member and provider grievances, complaints, and appeals in compliance with CMS, NCQA, and state requirements. You will research information from multiple sources, document findings,...Cms
- Harbor Health in Texas seeks an experienced Appeals & Grievances Director to lead the health plan's appeals and grievances function across Texas... ...of member and provider appeals and grievances, ensuring CMS, TDI, and NCQA compliance. Lead a team and collaborate with Compliance...Cms
- Kelsey-Seybold Clinic in Pearland, part of the Optum family, seeks an Appeals and Grievances Coordinator to manage Medicare reconsiderations, grievances, and appeals in line with CMS rules. This role acts as the primary liaison for the CMS regional office and coordinates...CmsWork at office
- 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...Cms
- Solis Health Plans is hiring for the Grievance and Appeals Analyst I position based in New York. This role involves reviewing member grievances and appeals, ensuring compliance with CMS and NCQA guidelines. Ideal candidates will have at least 2 years of experience in managed...CmsWork at office
- ...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
- Harbor Health seeks an experienced Appeals & Grievances Director to lead the health plan's appeals and grievances function across Texas markets, ensuring CMS/TDI/NCQA compliance and timely resolutions. You will manage a team, collaborate with Compliance, Legal, Claims,...Cms
$30 - $35 per hour
...Now Hiring: Grievance & Appeals Specialists Are you an experienced Grievance & Appeals professional with a background in Medicare or Medicaid... ...someone who thrives in a fast-paced environment, understands CMS regulations, and enjoys ensuring members receive timely,...CmsWork at officeImmediate start- ...Grievance & Appeals CoordinatorAre you an analytical problem solver with a passion for healthcare managed care? We are seeking dedicated Grievance... ...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
- ...The Utilization Management Nurse performs medical necessity and... ...coverage while working remotely.Primary Responsibilities:Performs... ..., Disease Management, Appeals & Grievances, and Quality Departments as... ...review.Proficient in MCG and CMS criteria setsExperience with...Remote workCmsContract workWork at office
- ...Appeals and Grievance Specialist II (Managed Care) – Irving, TX | 12-Week ContractLocation: Irving, TX Job Type: 12-Week Contract Company: Sigma... ...CPT and ICD coding.Familiarity with Medicare-covered benefits, CMS, and TRICARE regulations.Experience with medical terminology....CmsContract workMonday to Friday
$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- ...Management (UM) Registered Nurse to support outpatient... ...facilities.Participate in appeal reviews and provide... ...work independently in a remote environment.Comfortable... ...experience with appeals, grievances, or denial reviews.Knowledge of NCQA, CMS, and utilization management...Remote workCmsContract work
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