RN Appeals and Grievances Specialist

Job Summary

Working remotely in a full-time capacity, the RN Appeals and Grievances Specialist will manage the appeals process, review grievances, and ensure compliance with regulatory requirements.

Key responsibilities

• Manage and oversee the appeals process for clinical cases
• Review and investigate grievances to ensure compliance with healthcare regulations
• Collaborate with clinical teams to resolve issues and improve patient outcomes

Required qualifications

• Active RN, LPN, or Dental Hygienist license
• Experience in appeals and grievances within a healthcare setting
• Knowledge of healthcare regulations and compliance standards
• Strong analytical skills for reviewing clinical cases
• Ability to work independently in a remote environment