Remote Appeals & Grievances Clinical Specialist RN
$71.59k - $116.48kHealth First
- Remote job
A prominent healthcare organization is seeking an A&G Clinical Specialist to manage health member complaints and appeals. This fully remote position requires expertise in clinical case management, understanding of regulatory compliance, and the ability to effectively resolve cases independently. The ideal candidate should be an RN, LPN or Dental Hygienist with experience in appeals. Offering a competitive salary range of $71,594 - $116,480, this role includes various benefits such as health coverage and 401k contributions. #J-18808-Ljbffr Health First
$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$81.1k - $116.48k
Position Summary: The Appeals & Grievances (A&G) unit manages... ...authorization of or delivery of clinical and non-clinical... .... The A&G Clinical Specialist is the subject matter... ...position is 100% Remote. We are hiring for the... ...Minimum Qualifications: RN, LPN OR Dental...Remote jobContract workTemporary workWork experience placementLocal areaMonday to FridayShift 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
- Apolis is seeking a Grievance and Appeals RN in Phoenix, AZ (or remote within AZ time zone) to review and investigate member and provider grievances and appeals for Medicare Part C and Part D. The nurse reviews medical records, claims, authorizations, and plan benefits...Remote job
- Solü Technology Partners is seeking a Med Appeals & Grievance Specialist Coordinator (Clinical) for a 5-month contract based in Phoenix, AZ. The role focuses... ...volumes and coordinating with internal departments. Remote work is available; schedule 8:00-4:30 Mountain Time....Remote jobContract work
- Healthfirst is seeking an A&G Clinical Specialist to lead the development and resolution of clinical cases for member and provider appeals, ensuring compliance with applicable laws and internal policies. The role can be remote or on-site at the NYC or Lake Mary locations...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 Coordinator Are you an analytical problem solver with a passion for healthcare managed care? We are seeking dedicated... ...Coordinators 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
- ...Cancer Institute in Boston seeks a Clinical Authorization Specialist to manage prior authorizations for molecular... ...physicians and payers, and guide appeals when denials occur. The role... ...sensitive information in a fast-paced environment. #J-18808-Ljbffr Remote JobsRemote work
- ...experienced Registered Nurse to review and appeal denials across the system. You will research payer policies and craft clinical justification while coordinating with revenue... ...contributing to denial-prevention initiatives through training and reporting. #J-18808-Ljbffr Remote JobsRemote work
- ...Description: Job Description The Clinical Appeals Specialist reviews clinical denials involving medical... .... Maintain a private and secure remote work environment suitable for handling... ...Required Qualifications Active RN, MD, or DO credential. Three to five...Remote work
$248.5k - $373k
...0.00 - $373,000.00Job Area: Medical & Clinical OperationsCompany: UnitedHealth GroupAt... ...!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...Remote workMinimum wageWork experience placementLocal areaWork from home- ...Recovery in Plano, TX is seeking an experienced Registered Nurse (RN) to move beyond bedside care into a strategic, analytical role focused on utilization management, clinical review, and denial appeals. You will analyze denied claims, perform medical necessity reviews...
- ...and level of care, including appeal requests initiated by providers... ...stays, etc. using approved clinical protocols. Analyze, research... ...to UM decisions and appeals/grievances. Review claims issues... ...Renaissance Ctr, Detroit, MI, 48243, US (Remote) UST HealthProofRemote workWork at officeLocal area
$19.76 per hour
...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, you will review incoming complaints, investigate complex...Remote workHourly payPermanent employmentTemporary workWork experience placementWork at officeWork from homeHome officeMonday to FridayShift workWeekend work$22.99 per hour
...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... ...role in investigating issues, analyzing clinical records, carrying out necessary...Remote workHourly payPermanent employmentTemporary workWork experience placementWork at officeWork from homeHome officeShift workWeekend work- ...Medica is seeking an Appeals and Grievance Specialist to manage member complaints, grievances, and regulatory... ...will determine whether cases are clinical or non-clinical, route them to the... ...Services, Legal, and Markets. This is a remote position with a competitive total...Remote work
$38.91 - $60.31 per hour
...an onsite role and does not offer a hybrid or remote option Summary: Measures, analyzes, and facilitates improvement in clinical performance and outcomes. Responsibilities... .... ~ State licensure as a Registered Nurse (RN). Relevant certification as determined at...Remote workFull timeTemporary workLocal areaFlexible hoursShift work- ...WNS, part of Capgemini, is seeking a remote RN/LPN for utilization review in the United States. The role involves assessing medical necessity, resolving escalations, and maintaining HIPAA-compliant documentation with HealthHelp policies. Requires active nursing license...Remote workWork at office
- 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
- Centene is 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...Remote job
- 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
$75k
...Clinical Specialist For Wound Care Supplies Asure Wound Solutions is seeking a highly skilled and dedicated Clinical Specialist for Wound Care Supplies to join our team. This is a remote position based in the Dallas area and requires experience working in nursing homes...Remote workWork at officeMonday to FridayShift work- Northern Light Health is seeking a Clinical Assurance Specialist for the Home Care and Hospice division in Maine. The role focuses on analyzing clinical... ...regulations. The position is based in South Portland with remote options and a full-time schedule from 8:00 AM to 5:00 PM....Remote workFull time
- ...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
- $10,000 Sign On Bonus Position Overview The RN Clinical Management Specialist is a qualified professional responsible for collaboration with Home Health and Hospice leadership in planning, coordinating, and delivering quality services to the client. This is a regional...Remote workFull timeInterim roleWork at officeRelocation package
- Optum, a UnitedHealth Group company, seeks a Clinical Review Clinician to serve as a subject matter expert for itemized bill reviews and hospital facility bill analysis. You will document, research, and identify adjustments for payment as part of Forensic Reviews for clients...Remote job
$62.15k
...are currently seeking a BPO Clinical Review Specialist to join our team in Tampa,... ...processing of member and provider appeals. This role evaluates... ...benefits. Position is fully remote only in the state of... ...requirements governing appeals and grievance processes. Required to...Remote workPermanent employmentFull timeTemporary workLive inWork at officeImmediate startRelocationFlexible hours$70k - $80k
...Piper Companies is seeking a Remote Clinical Appeals Analyst to provide clinical expertise in reviewing and resolving complex member and provider... ...must hold an active North Carolina licensure as an RN, LPN, PT, or OT and have significant clinical experience. The...Remote workFull timeContract workMonday to Friday
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote Appeals & Grievances Clinical Specialist RN. Be the first to apply!
- clinical specialist crm New York, NY
- public health educator New York, NY
- clinical applications specialist New York, NY
- field clinical specialist New York, NY
- clinical specialist New York, NY
- clinical nurse specialist New York, NY
- clinical nurse educator New York, NY
- clinical support specialist New York, NY
- clinical sales specialist New York, NY
- clinical educator New York, NY



