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Appeals & Grievances Case Manager (California)

Pyramid Consulting, Inc
  • 🇺🇸 United States
  • Hybrid
  • Manager or above
  • 1 day ago
  • CMS
1 day ago
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Immediate need for a talentedAppeals & Grievances Case Manager (California). This is a06+ Months Contract opportunity with long-term potential and is located inCalifornia (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 leadingHealthcare 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.
 
Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy here.

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Appeals & Grievances Case Manager (California) · Pyramid Consulting, Inc

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