Remote Appeals & Grievances Case Manager - Health Plan
$27 - $31 per hourPyramid Consulting, Inc
- Remote job
Pyramid Consulting, Inc. is seeking an Appeals & Grievances Case Manager for a California assignment in Los Angeles. This is a 06+ months contract with potential for extension, and is listed as remote in the LA area. The role requires extensive appeals experience within health plans, including member, provider, and authorization appeals, as well as familiarity with CMS, DMHC, and NCQA standards. The pay range is $27-$31 per hour, with traveler benefits as per agency package. #J-18808-Ljbffr Pyramid Consulting, Inc
$248.5k - $373k
...simplifying the health care experience,... ...flexibility to work remotely * from anywhere... ...Responsibilities:The Appeals and Grievances Medical Director... ...and grievances cases for UnitedHealthcare... ...various health plan and insurance... ...Insurance/Department of Managed Healthcare, and...Remote workHealth InsuranceMinimum wageWork experience placementLocal areaWork from home$30 - $35 per hour
...seeking a Mid-Senior Level professional for a contract role to manage grievances and appeals. Candidates should have 6+ years in customer service with... ...range of $30.00/hr - $35.00/hr based on qualifications. Remote work is available for candidates within 100 miles of...Remote jobContract workFor contractors- ...UnitedHealth Group is seeking a senior Appeals and Grievances Medical Director to lead... ...United States. You will perform case reviews for multiple health plans, address regulatory responses,... ...clinical plus 2+ years in quality management. #J-18808-Ljbffr Jobleads-USRemote jobHealth InsuranceWork from home
- ...UnitedHealthcare is seeking an Appeals and Grievances Medical Director to lead clinical... ...and grievances across multiple health plan products. This role offers remote work from anywhere in the U.S.... ...quality. Responsibilities include case reviews, regulatory responses, collaboration...Remote jobHealth Insurance
- Community Health Plan of Washington is seeking a Case Manager I to deliver telephonic case management for members with acute, chronic, and complex health needs. The role emphasizes coordinating care with providers, family, and community resources to improve quality of life...Remote jobHealth Insurance
- A health organization is seeking a Remote Case Manager in Washington. The role focuses on case management services for members with complex needs. Ideal candidates... ...environment with a commitment to equity and inclusion. #J-18808-Ljbffr Community Health Plan of WashingtonRemote jobHealth Insurance
$39 per hour
A health services provider is seeking a Care Manager RN for a remote, contract role in Detroit. This position involves leading a multidisciplinary team to deliver holistic... ...of clinical nursing experience and prefer prior case management experience. The position offers a...Remote jobHealth InsuranceContract work- Iconma LLC is seeking an RN Case Manager to work remotely for a health insurance client in Michigan. The role involves coordinating a multidisciplinary team... ...channels to develop and monitor individualized care plans, assess needs, and promote positive health outcomes. Responsibilities...Remote jobHealth Insurance
- hireops is seeking to fill a work-from-home position with field visits for conducting medical management and health education programs for government health care customers. The ideal candidate will have 3 years of clinical care experience and a relevant license. Responsibilities...Remote jobHealth InsuranceWork at officeWork from home
- ...UnitedHealth Group is seeking a physician leader to conduct case reviews for appeals and grievances across multiple health plans. The role involves regulatory responses, collaboration with medical directors, and guidance on benefit interpretations. You will participate...Remote jobHealth Insurance
- Trillium Professional is seeking a Member Appeals Specialist for a 100% remote, 13-week contract at $24.79/hour. You will independently manage appeals from intake through final resolution for non-Medicare health plans. Responsibilities include maintaining a caseload of...Remote jobHealth InsuranceContract work
$320k - $350k
Site: Mass General Brigham Health Plan Holding Company, Inc.Mass... ...clinical operations, network management, quality, and compliance... ...complex or escalated cases, appeals, and grievances, and ensure UM policies align... ...Job Details (if applicable)Remote TypeRemoteWork Location399...Remote workHealth InsuranceFull time$94.5k - $171.7k
...gadget, it's about making health care data available... ...products for the health plan market that focus on comprehensively... ...3+ years of Product Management/Product development... ...to develop business cases, champion alignment,... ...Telecommuting, Work from Home, Remote, Eden Prairie, MN,...Remote workHealth InsuranceTemporary workWork experience placementLocal areaWork from homeFlexible hours- L.A. Care Health Plan is seeking an Appeals and Grievances Specialist II in Los Angeles, CA. The role involves investigating member and provider complaints... ...preparing reports. Requirements include at least 2 years in Managed Care, knowledge of medical terminology, and excellent...Remote jobHealth InsuranceFull time
- ...UnitedHealthcare is seeking a clinician to review appeals and grievances across PPO, HMO, MAPD and PDP products... ...and network staff. We offer remote work from anywhere in the U.S. The... ..., communication, and project-management skills to help improve care access and...Remote job
$150k - $188k
...of care, including hospitals, health systems, medical groups, academic... ...investors, and payers/health plans. Our work focuses on creating... ...our clients optimize their managed care contract portfolios and develop... ...engagement. We will consider remote hires, but prefer an in‑office...Remote workHealth InsurancePermanent employmentFull timeContract workWork at office2 days per week- ...arrangements that include remote and hybrid... ...loan repayment. We offer health, dental, and vision insurance... ...bonuses and investment plans, and are committed to growing... ...What you will do: Manage members through the... ...concurrent review, screening cases for quality-of-care...Remote workHealth InsuranceFull timeWork at officeLocal areaWork from homeFlexible hours2 days per week1 day per week
$83.1k - $120.36k
...Position Summary: The Appeals & Grievances (A&G) unit manages Healthfirst member... ...for all clinical case development and case... ...Manages all Department of Health (DOH) and executive... ...This is either a remote or on-site position... ...'s internal health plans policies and procedures...Remote workHealth InsuranceContract workTemporary workWork experience placementLocal area- Community Health Plan of Washington is seeking a Remote Case Manager to manage case delivery and coordination programs. Successful candidates will have a strong nursing or social work background, managing members' healthcare needs while promoting their quality of life....Remote jobHealth Insurance
$92.4k - $133.67k
...do.Today, SCAN is a nonprofit health organization serving more than... ...The JobThe Contracting Systems Manager serves as the contracting... ...healthcare or health insurance plan operations.Experience interpreting... ...0-1.35(c)SummaryLocation: Long Beach, CA; Remote, USType: Full timeRemote workHealth InsuranceOngoing contractFull timeContract workFor contractorsWork at office- Universal Health Services in Rosemead, California, is seeking a Case Manager to manage treatment activities for patients in a psychiatric setting. This role requires... ...experience. The Case Manager will implement treatment plans, maintain patient contact, and ensure appropriate...Health Insurance
- ...Springs Healthcare in Surprise, AZ, is seeking a Case Manager to support Social Workers by assisting with discharge planning, coordinating care, and documentation.... ...communication skills, and experience in behavioral health. The role operates in a clinical setting, and...Health Insurance
- ...Shift : 8:00 AM - 5:00 PM Remote with member facing... ...Long-term Service Care Manager to join our team. In this... ...assessments, and coordinate health services to ensure... ...members with complaints and appeals Qualifications Bachelor... ...Health, or Discharge Planning) Familiarity with...Remote workHealth InsuranceContract workWork at officeLocal areaWork from homeShift work
$60.78k
...Appeals and Grievances Specialist II Job Category: Customer Service... ...in 1997, L.A. Care Health Plan is an independent public... ...DHCS), Department of Managed Health Care (DMHC),... ..., prepares case files and routes complaints... ..., holidays, a hybrid remote schedule, occasional...Remote workHealth InsuranceFull timeLocal areaShift workWeekend work$60.52k - $129.62k
...re building a world of health around every individual... ...providers, hospitals, care management teams, and community... ...through education, case consultation, problem-solving... ..., including both remote work and regular onsite... ...coordination processes, discharge planning, community resources,...Remote workHealth InsuranceHourly payFull timeTemporary workLive inLocal areaMonday to Friday$102.18k
RN Job Supervisor, Appeals and Grievances Clinical Operations RN Shift Full Time Pay Range $1... ...the nation's largest publicly-operated health plan, we have a great responsibility to... ...Opportunity. Amazing co-workers. A supportive management team. Great compensation and benefits...Health InsuranceFull timeShift work$107.7k - $199.3k
...Centene is transforming the health of our communities, one... ...resolution, escalation management, communications and... ...Legal, IT, and Health Plan teams to address systemic... ...timely and accurate case management. Ensures compliance... ...approach to work with remote, hybrid, field or...Remote workHealth InsuranceFull timePart timeWork at officeFlexible hours$80k
Who We Are Redirect Health exists to make healthcare affordable for... .... About This Role The RN Case Manager serves as the primary clinical... ...ensuring employees in self‑insured plans receive the right care at the... .... Comfortable working in a remote, tech‑enabled environment....Remote workHealth Insurance- ...Livingston, TX is seeking a dedicated RN Case Manager to oversee patient care and manage LVNs... ...ensure comprehensive care and discharge planning for patients. The ideal candidate must hold... ...have a preference for 2 years of Home Health experience. Competitive benefits include...Health Insurance
- AccentCare Inc. is seeking an RN Case Manager for our Home Health team in Georgia. The role focuses on managing patient care plans from admission through discharge and ensuring high-quality care delivery. You will lead and coordinate RNs, LPNs, and CHHAs to implement the...Health Insurance
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