Appeals & Grievances Case Manager (California)

Immediate need for a talented Appeals & Grievances Case Manager (California) . This is a 06 Months Contract opportunity with long-term potential and is located in California (Remote). Please review the job description below and contact me ASAP if you are interested.

Job ID:26-31017

Pay Range: $27 - $31/hour. Traveler benefits as per agency package. (Benefits vary by vendor and assignment.)

Key Responsibilities:

• 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.
• This role ensures timely and fair resolutions accurate documentation and strong cross-functional collaboration.

Key Requirements and Technology Experience:

• 2 years experience in Appeals Grievances Utilization Management or Care Coordination in a health plan or TPA.
• Strong understanding of CMS DMHC and NCQA regulatory standards.
• Required Qualifications
• 5 years of Appeals & Grievances experience within a Health Plan or Managed Care organization
• Experience handling:
• Member Appeals
• Provider Appeals
• Claims Denials
• Authorization Appeals
• Benefit Determinations
• Knowledge of:
• CMS
• DMHC
• NCQA
• Medicare
• Medi-Cal
• Commercial Health Plans
• Excellent written communication skills
• Experience reviewing medical records and clinical documentation

Our client is a leading Healthcare Industry and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position please apply online for immediate consideration.

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