Grievance and Appeals Quality Review Specialist
VNS Health
Build the career you want and make a powerful impact.NursingAs a professional and skilled home care nurse with VNS Health, you will flourish in an environment which encourages growth and provides opportunities to advance your nursing career. While using your expertise to provide life-changing care for New Yorkers, you will thrive in the unique and dynamic practice setting. Social WorkAs a focused and dedicated social work provider with VNS Health, you will connect with people and communities in need to provide your expertise and act as their advocate. You will help them adjust to changes and challenges in their lives and to access services and resources to improve their quality of life.CorporateAs a caring and strategic corporate professional with VNS Health, you’re a key provider of services in a variety of areas across the organization. The unique skills and expertise you bring to the organization will help to impact the communities we serve.Home Health AidesAs a crucial part of the care delivery team, our home health aides play a critical role in making a difference in our patients’ lives. Whether you are assisting with the activities of daily living, checking vital signs or sharing conversation, you help patients maintain their ability to live in the comfort of their homes.Health Plans and Plan ServicesOur health plans work closely with both plan members and their health care providers to keep our members’ health on track. From managing populations requiring long term services and supports, to complex cases and end-of-life and palliative care, you will play a critical role in delivering coordinated care to plan members. Our plan services team is integral in providing administrative and health management functions necessary to deliver top quality outcomes, while simplifying the health care experience for all.Rehabilitation TherapyAs a skilled and knowledgeable therapist, you work as a key member of an interdisciplinary team treating patients in the comfort of their own homes. You have access to the newest technologies and best-practice protocols to help patients reenter the community with the strength to live rewarding lives.The future of care really does begin with you! At VNS Health, we are working every day to revolutionize health care in the home and community. As part of this effort, we are fostering a growth mindset and building strong leadership capabilities at all levels.We’re also nurturing an inclusive culture that encourages innovation and creativity, so we can generate the solutions we need for our patients, clients and plan members— a place where you can grow in your career, be challenged, and learn new things.I am continually inspired by our employees’ strong commitment to the organization and our 130-year-old mission of bringing essential care to vulnerable populations. I hope you’ll consider joining VNS Health, and becoming a part of that mission yourself.Dan Savitt President and Chief Executive OfficerWe’re excited to share that VNS Health was named to Crain's New York Business's "Best Places to Work in NYC for 2025" list! This recognition reflects the fact that VNS Health is an outstanding place to work.A big thank you to our team members — their commitment to our culture and values have been instrumental in achieving this designation.Mission & ValuesAs a team member of VNS Health, you share a passion for improving the health of patients through best-in-class care in the home and the community.
- ...available to applicants in any of our U.S. States except NY, CA, and AK Quality Review Specialist Work closely with Utilization Management (UM), Case Management (CM) and Customer Service (CS) to ensure appeal process meets established guidelines. Adhere to accreditation and...SuggestedRemote workShift workWeekend work
- AI Trainer Jobs is seeking a Python code reviewer to assess model-generated code snippets and prompts. You will identify bugs, analyze... ...preferences among several variants. The work is remote and performance-driven, with a focus on quality over quantity. #J-18808-Ljbffr ClaruSuggestedRemote work
$60k - $65k
...yrly Position Summary: The Quality Improvement Specialist is responsible for implementing... ...Conduct and analyze data from random reviews of case records to evaluate the timeliness... ..., facilitation of focus groups, grievance investigations and post-services follow...SuggestedLocal area- AuraOne, Inc. is seeking an AI Agent Interaction Specialist to remotely review ai agent interaction evaluation prompts and responses against AuraOne's quality rubric. You will compare paired outputs, label edge cases, and write structured feedback for the modeling team...SuggestedRemote work10 hours per week
- AllMed Medical Management is seeking a Clinical Quality Assurance Coordinator. This 100% remote role supports Pacific Time Zone operations... ...PST schedule. The position focuses on high-quality utilization reviews and adherence to evidence-based guidelines, HIPAA, URAC, and...SuggestedRemote job
$35 - $50 per hour
...Registered Nurse for a remote role providing clinical technology services. This position is for independent contractors, focusing on chart reviews and clinical data analysis. Candidates should have an active RN license, at least 3 years of adult health experience, and strong...Hourly payContract workFor contractorsRemote work$68k - $80k
# Join the WRIGHT Team!## Quality Systems SpecialistApply: US-PA-Newtown (TTC): Full time... ...Posted Today: JR14113**Quality Systems Specialist**The Quality Systems Document Control Specialist... ...requirements.* Oversees the creation, review, approval, and distribution of...Full time- Dexian is seeking a contractor for a 3+ month remote assignment to review AML investigation cases for accuracy and completeness, independently researching customer and transaction information, and ensuring all risk factors are addressed. You will review SAR narratives,...Remote jobFor contractors
- ...writing and keen visual acuity are essential. Based in the United States is preferred, but the role is open to worldwide applicants. This position emphasizes careful review over speed and requires adherence to project guidelines to ensure #J-18808-Ljbffr ConfidentialRemote jobFor contractorsWorldwide
- Ethos is seeking experienced QA specialists to help train an AI model on professional documents, spreadsheets, and slide decks. This remote... ...role is 5-20 hours per week with an ASAP start. You will review and proof materials before client delivery, focusing on accuracy...Remote jobImmediate startFlexible hours
$55k - $75k
...for an accommodation or an alternative application process. Quality Specialist Quality Control - External Full Time US Salary Range: $... ...document management controls, change control, batch record review, deviation and CAPA management, and will be responsible for electronic...Full timeContract workTemporary workLive inRemote workRelocation$73.88k - $122.53k
...Days) Overview: Sentara Health is looking to hire a Remote Quality Improvement Specialist. This is a remote position: Remote opportunities... ...for conducting comprehensive clinical and documentation reviews of behavioral health claims prior to payment to ensure services...Full timeTemporary workWork at officeRemote workShift work$21 - $23 per hour
...Aston Carter is hiring for Customer Service Quality Specialists! Job Description The Quality Specialist reviews and evaluates customer service calls to ensure they meet established quality, compliance, and performance standards within U.S. healthcare operations. This role...Contract workTemporary workRemote workWork from home- AuraOne, Inc. seeks an experienced UX/UI Expert reviewer to assess AI outputs within ux/ui operations workflows. You will apply multi-page rubrics to evaluate tone, escalation logic, and stakeholder fit, flagting risks and documenting next steps for model training. The...Remote jobPart timeFor contractors10 hours per week
- ...Description Job Status: Non-Exempt Job Summary: The quality specialist is responsible for analyzing calls, emails, social media posts... ...or after the fact to ensure proper workflow is being used Review contacts for customer satisfaction Provide recommendations...For contractorsWork at officeLocal areaRemote workNight shiftWeekend workAfternoon shift
$48.4k - $72.6k
...Healthsource blog: . Join the Provider Contact Center Quality Program as a Quality Specialist II and help shape quality across our offshore... ...facilitating team meetings and work groups regarding Quality Review & Reporting initiatives and incentives. Understand quality...Work experience placement$26 - $28.5 per hour
Immediate need for a talented Quality Review and Audit Analyst . This is a 03+ months contract opportunity with long-term potential and is... ...(AAPC): Certified Professional Coder (CPC) Certified Coding Specialist for Providers (CCS-P) Certified Coding Specialist for Hospitals...Contract workLocal areaImmediate startRemote work$20 - $50 per hour
AuraOne, Inc. is seeking a Quality Analyst for a remote review track evaluating AI outputs across QA workflows. Reviewers grade workflow correctness, policy adherence, and stakeholder fit; flag operational risk; and document the right next steps for model training. This...Remote jobHourly payFor contractors10 hours per weekFlexible hours$60.1k - $98.7k
The Clinical Readmission Review Quality Analyst oversees work performed by Clinical Readmission Review Auditors to ensure EXL’s standard of accuracy, consistency, and documentation quality is met. The analyst performs quality reviews of random and targeted samples of completed...Remote work$45k - $65k
...an auditing background or other relevant experience to join our Quality Assurance team. This is an excellent opportunity for someone... ...to individuals with psychiatric or developmental disabilities Review documentation and practices to assess compliance with applicable...Full time$65k - $75k
...Job Title: Supplier Quality Specialist Location: New York, NY (Flatiron HQ) - 3 days onsite, 2 days remote Reports To: Supplier Success Manager... ...team flags issues with incoming supplier shipments; review reported non-conformances, damage, and shortages against purchase...Temporary workWork experience placementRemote work3 days per week$80.5k
...Description Job Title: Senior Clinical Quality Specialist Job Summary: CASES is looking... ...incident committee meetings to review and monitor the program response to... ...special investigation policies and client grievances, while maintaining a high level of...Full timeWork at officeLocal areaRemote workMonday to FridayShift work1 day per week- Remote Service Quality Review Associate Entry-Level | Remote Opportunity | Training Provided We are seeking a detail-oriented team member to help review service interactions and ensure information is communicated clearly and consistently. This position is suitable for...Remote job
- Virtix Health, LLC is seeking a Clinical Quality Reviewer (Coder/Auditor) to perform comprehensive clinical reviews for WISeR Prior Authorization, validating documentation for medical necessity under CMS guidelines. This remote US role operates in a 24/7 review environment...Remote job
$35 per hour
...while collaborating with a passionate team. If you’re ready to embark on this adventure, your journey in quality assurance awaits! Roles: In this role, you’ll help review mobile apps by installing them on your device and testing how they perform. You’ll look at ease of...Hourly payContract workFixed term contractStart working todayRemote workWork from home- Verita AI is seeking subject matter experts to review AI conversations and assess whether sufficient context was gathered before recommendations were made. You will identify missed opportunities for clarification and provide structured feedback to improve AI systems. The...Remote job
$120k - $160k
...About the Job We are seeking an experienced Senior Quality Systems Specialist to join Synchron’s Quality team. This is an amazing opportunity... ...records in accordance with internal procedures Management Reviews - Support Quality Management Reviews, including taking meeting...Full timeTemporary workFor contractorsInternshipFlexible hours- AuraOne seeks a Moonlight MCQA - Arabic Generalist to remotely evaluate Arabic outputs against native-speaker standards. Reviewers assess fluency, register, and cultural-context accuracy, then provide structured rationale for model improvement in the next training cycle...Remote jobHourly payFor contractorsFreelance
- ## Clinical Quality Reviewer (Coder/Auditor)Apply: US - Remote: Full time: Posted Yesterday: JR106450**About Us:**Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve...Full timeWork at officeImmediate startRemote workFlexible hoursAfternoon shift
- YPAI is seeking a detail-oriented reviewer to evaluate annotation and transcription work from home in the United States or other supported... ..., score items, and provide clear written feedback to ensure quality of data. Responsibilities include resolving disagreements, calibrating...Remote jobWork from home
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