Director, Appeals & Grievances (Remote)
Sentara Health
- Remote job
Sentara Health is seeking a Director of Appeals and Grievance to plan, develop, and direct department services for existing and new business opportunities. You will set strategic long-term goals for Commercial, Medicaid, and Medicare, partnering with Medical Directors to refine criteria and benefits. You will oversee complaints and grievances reporting, ensure compliance with contracts and regulations, and manage audits (NCQA, EQRO, CMS, DMAS, BOI). Remote.US remote work supported. #J-18808-Ljbffr Sentara Health
- Overview The Director of Appeals and Grievance will plan, develop, and direct the department services and activities for all existing and new business... ...Plans Education Bachelor\'s Degree (Required) Location Remote Experience Minimum five years of experience with Healthcare...Remote work
- ...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
- ...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
- Position Overview Harbor Health is seeking an experienced Appeals & Grievances Director to lead the health plan's appeals and grievances function. In this role, you will oversee the intake, investigation, and timely resolution of member and provider appeals and grievances...Suggested
- 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,...Suggested
$248.5k - $373k
...Growing together.Work at home!You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities:The Appeals and Grievances Medical Director is responsible for ongoing clinical review and adjudication...Remote workMinimum wageWork experience placementLocal areaWork from home- ...an experienced leader to head the Prior Authorization team. This role ensures timely submissions, accurate outcomes, and effective appeals while coordinating with across departments to optimize workflows. Strong focus on clinical relevance and policy adherence guides decision...Remote job
$22.99 per hour
...analytical problem solver with a passion for healthcare managed care? We are seeking dedicated Grievance & Appeals Coordinators to join our growing, collaborative team! In this fully remote role, you will analyze and resolve complex member and provider appeals and grievances,...Remote workHourly payPermanent employmentTemporary workWork experience placementWork at officeWork from homeHome officeShift workWeekend 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
$145.23k - $163.39k
A large transportation authority in New York City seeks a Director of Labor Relations and Grievances to oversee labor management functions, guide contractual negotiations, and manage grievances. The ideal candidate should possess a Bachelor's degree in Labor Relations...Remote job- ...Medica is seeking an Appeals and Grievance Specialist to manage member complaints, grievances, and regulatory inquiries, ensuring timely, accurate... ...Operations, Health Services, Legal, and Markets. This is a remote position with a competitive total rewards package. #J-1880...Remote work
- ...To support a growing remote team, the full-time Appeals and Grievance Specialist will manage and resolve complaints, grievances, and appeals from members and providers while ensuring compliance with applicable requirements. Key responsibilities Manage and resolve complaints...Remote workFull time
- Santa Barbara Cottage Hospital is seeking a Grievance and Appeals Nurse for a remote position based in Indiana. Responsibilities include investigating... ...for necessity, and preparing recommendations for Medical Director approval. Candidates need at least 2 years in managed...Remote job
- A staffing solutions company is seeking a Grievance & Appeals Coordinator for a fully remote position in Detroit, MI. This role involves processing appeals, grievances, and inquiries while maintaining accurate documentation and effective communication. The ideal candidate...Remote jobContract work
- 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...Remote jobContract work
$23.22 - $34.84 per hour
A leading health insurance provider is seeking a Grievance & Appeals Coordinator to work virtually full-time, with responsibilities including summarizing complaints, ensuring resolution of grievances, and documenting interactions. The ideal candidate should possess a high...Remote workHourly payFull time$22 - $23 per hour
A leading healthcare consulting firm is seeking a Grievance & Appeals Coordinator for a remote position. This role involves processing and resolving member appeals and grievances while maintaining compliance with healthcare regulations and quality standards. Candidates...Remote jobContract work- ...seeking a clinical professional to join our Medical Management/Health Services team to ensure proper processing of member grievances, provider appeals, and state fair hearings. You will serve as the primary contact with the State and oversee the daily activities of the...Remote job
$30 - $35 per hour
...Mid-Senior Level professional for a contract role to manage grievances and appeals. Candidates should have 6+ years in customer service with strong... ...pay 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 an Associate Director of Business Process, Claim & Appeal Operations to drive enterprise-level initiatives and oversee financial planning, performance management, and governance across the organization. The role partners with the VP to implement...Remote job
- ...Job Title: Grievance & Appeals Coordinator I Location: Remote in Indiana (**MUST be a resident of Indiana) Pay: $22 hourly - *weekly pay Position Purpose: Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal...Remote workHourly payWeekly pay
- Firstsource Healthcare is seeking a detail-oriented Claims & Appeals & Grievances (A&G) Specialist to join our Healthcare Operations team. The candidate should have at least two years of experience in US healthcare back-office operations with expertise in claims processing...Remote job
- Elevance Health is seeking a Grievance/Appeals Analyst I to join the Enterprise Grievance & Appeals Department. This entry level role reviews, analyzes and processes non-complex grievances and appeals from diverse customer types across multiple products, focusing on quality...Remote job
$112.7k - $193.2k
...Caring. Connecting. Growing together. The Associate Director Business Process, Claim & Appeal Operations serves as a key strategic partner to the Claim... ...Operations. You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough...Remote jobMinimum wageFull timeTemporary workWork experience placementWork at officeLocal area- Sentara Health Plans in Virginia Beach region seeks a Director of Appeals and Grievance to plan, develop, and direct the department across Commercial, Medicaid, and Medicare lines of business. This role leads program development, strategic planning, and operational execution...Remote job
- Sentara Health Plans is hiring a Director of Appeals and Grievance to lead the department across Commercial, Medicaid, and Medicare lines. You will... ...managing audits and performance against KPIs. The role offers remote work with a strong focus on collaboration with Medical...Remote job
- ...Job Title Job Description Process appeals and grievances, analyze, research, and provide comprehensive responses in accordance with established... ...applying contract and regulatory provisions. This is a Remote Role Experience Experience handling a large load of...Remote workContract workApprenticeshipLocal area
- ...Position: Business Analyst III - Appeals & Grievances Location: Los Angeles, CA, US (Remote) Duration: Permanent Job Description: The Business Analyst III facilitates business process improvement via the methodical investigation, analysis, review...Remote workPermanent employmentWork at office
- ...Strategic Staffing Solutions is currently looking for a Grievance & Appeals Coordinator, a W2 contract engagement with one of our largest clients in Detroit, MI! REMOTE!! Title: Grievance & Appeals Coordinator Location : Detroit, MI (Fully Remote) Duration:...Remote workContract work
$22.99 per hour
...detail-oriented professional to analyze and resolve verbal and written claims and authorization appeals from providers, as well as pursue the resolution of formal grievances from members. You will be joining a highly collaborative team dedicated to closely supporting our...Remote workHourly payPermanent employmentTemporary workWork experience placementWork at officeShift work
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