Appeals & Grievance Manager

Immediate need for a talented Appeals & Grievance Manager. This is a 12 months contract opportunity with long-term potential and is located in Corona, CA(Remote). Please review the job description below and contact me ASAP if you are interested.

Job ID:

Pay Range: $30/hr - $32/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• Resolve member grievance and appeals cases, with a focus on healthcare coverage issues.
• Investigated and resolved member and provider grievances and appeals in alignment with CMS, DMHC, and NCQA regulatory guidelines.
• Drafted and issued clear, accurate, and timely written determinations, ensuring compliance with state and fede...