Clinical RN: Grievance & Appeals Specialist

VNS Health; New York (NY); On-site; USD 93,000 - 117,000; Full time

Benefits offered by this job

Referral bonus opportunities

Generous PTO and holidays

Health insurance for you and family

Employer-matched retirement savings

Job summary

VNS Health is seeking a Grievance & Appeals Specialist, Clinical RN in New York. You'll resolve grievances and external reviews for MLTC/MA/Select Health plans, ensuring regulatory compliance, timeliness, and accuracy.

You will document actions, communicate outcomes to enrollees/providers, and assist with data reporting in a fast-paced environment. The role requires an RN license in NY, a Bachelor's degree in nursing (Master's preferred), and at least three years in health care with two in

Qualifications

• License and current registration to practice as a registered professional nurse in New York State is required.
• Bachelor's Degree in Nursing is required; Master's preferred.
• Minimum three years progressive professional health care experience with at least two years in grievance/appeals.

Responsibilities

• Resolves grievances and appeals across MVTC/MA/MLTC lines ensuring regulatory compliance.
• Investigates routine and complex cases, documents actions and rationale clearly.
• Communicates outcomes to enrollees and providers; coordinates data collection and reporting.
• Ensures timely follow-up and maintains accurate records per procedures.

Skills

Verbal and written communication

Microsoft Office (Word & Excel)

Typing skills

Ability to manage multiple grievances/

Education

Bachelor's Degree in Nursing

Master's Degree in Nursing (preferred)

Tools

Microsoft Office (Word and Excel)

Job description

VNS Health is seeking a Grievance & Appeals Specialist, Clinical RN in New York. You'll resolve grievances and external reviews for MLTC/MA/Select Health plans, ensuring regulatory compliance, timeliness, and accuracy.

You will document actions, communicate outcomes to enrollees/providers, and assist with data reporting in a fast-paced environment. The role requires an RN license in NY, a Bachelor's degree in nursing (Master's preferred), and at least three years in health care with two in