Case Manager – Appeals & Grievances

Case Manager – Appeals & Grievances (California)

We are seeking a detail-oriented Case Manager – Appeals & Grievances to investigate, coordinate, and resolve member complaints, grievances, and appeals in compliance with health plan and regulatory standards.

Responsibilities Include

• Ensuring timely and fair resolutions of cases
• Maintaining accurate documentation
• Facilitating cross-functional collaboration
  
  

Qualifications

• Minimum of 3 years experience in Appeals, Grievances, Utilization Management, or Care Coordination within a health plan or TPA
• Strong knowledge of CMS, DMHC, and NCQA regulatory standards
  
  

The role offers remote work in California, with compensation ranging from $20 to $30/hour, along with benefits such as health insurance, 401(k), and paid sick leave. The position involves investigating and resolving member issues with attention to detail and compliance.