[Skip to main content](#main-content) [ OpenNash ](https://opennash.com/) / [Jobs](https://jobs.opennash.com/) [ 01 Search jobs](https://jobs.opennash.com/search/)[ 02 Companies](https://jobs.opennash.com/explore/)[ 03 Hiring report](https://jobs.opennash.com/reports/hiring/)[ 04 AI assistants](https://jobs.opennash.com/connect/)[ 05 How it works](https://jobs.opennash.com/methodology/) Centene · Remote-CA # Grievance & Appeals Nurse Remote-CA Remote Full-time $27.02 - $48.55 per hour Healthcare & Clinical Listed on Centene’s official careers site. Posted November 4, 2026. Check that it is still open and apply there. [Apply on Centene’s careers site →](https://centene.wd5.myworkdayjobs.com/centene_external/job/Remote-CA/Grievance---Appeals-Nurse_1674390) [OpenNash Jobs](https://jobs.opennash.com/) / [Centene](https://jobs.opennash.com/companies/centene/) / Grievance & Appeals Nurse ## Job description ### Position Purpose Facilitate medical necessity grievance, appeals and denials including disposition of denials notification letters, review of clinical information to determine if medical necessity criteria are met Key Details: Candidate must hold California RN Licensure. This position is remote and will work PST hours. Review clinical data to determine claim payment based on company policies and National Committee for Quality Assurance (NCQA) guidelines, including overturning denied claims, upholding the denials and submitting cases to the Medical Director for review Recognize and identify potential quality care concerns by reviewing member grievances and potential quality issue cases. - Prepare case review for the Medical Director in cases where criteria are not met based on the additional clinical information received - Identify system improvements or individual care issues that result in failure to provide appropriate care to members or fail to meet service expectations - Provide input into corrective action plans for clinical and service events to improve decision-making or quality of care and services for internal and provider partner decisions - Generate appropriate appeal resolution communication to the member and provider in accordance with company policies and NCQA guidelines. - Create system authorization events for overturned denial decisions - Request additional information, as appropriate from provider(s) to facilitate timely appeals resolution - Gather and prepare case information for Administrative Law Hearings - Maintain appeals process within the prescribed NCQA timeframes and appeals turnaround database - Assist the Medical Director with revising, updating and/or creating new policies to satisfy NCQA and contractual requirements May act as liaison between the provider and business to resolve issues - Performs other duties as assigned Complies with all policies and standards Education/Experience: LPN or LVN with 3+ years of clinical nursing experience or RN with 2+ years of clinical nursing experience. Experience with utilization or appeals review preferred. Knowledge of InterQual criteria preferred. ### License/Certification Current state's RN, LPN, or LVN license. Must be licensed in CA. ### Pay Range $27.02 - $48.55 per hour At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday. ### Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act ## At a glance - Posted by the employer: Nov 4, 2026 - First seen by OpenNash: Nov 8, 2026 - Last checked: Nov 8, 2026 - Listed for: 4 days - Location: Remote-CA - Work arrangement: Remote - Employment type: Full-time - Pay: $27.02 - $48.55 per hour[Apply on Centene’s careers site →](https://centene.wd5.myworkdayjobs.com/centene_external/job/Remote-CA/Grievance---Appeals-Nurse_1674390) ## Hiring at Centene - Open jobs: 393 - New in the last 7 days: After two weekly collections - Tracked since: Jul 11, 2026 [All Centene jobs](https://jobs.opennash.com/companies/centene/) · [Weekly hiring report](/reports/hiring/) ## More jobs at Centene ### [Behavioral Health Medical Director](https://jobs.opennash.com/companies/centene/jobs/41d12d2584acb3ed3beb/) Remote-CA ### [Pharmacy Technician (Specialty Outreach)](https://jobs.opennash.com/companies/centene/jobs/642faf0a35bd37995c35/) Remote-CA ### [Care Coordinator III](https://jobs.opennash.com/companies/centene/jobs/18397ea03fa8d392521b/) Remote-CA ### [Care Manager Transition of Care (RN)](https://jobs.opennash.com/companies/centene/jobs/51f429d04bbdcb8dbba7/) Remote-CA ## Similar jobs at other companies ### [Appeals and Grievance Supervisor](https://jobs.opennash.com/companies/universal-health-services/jobs/c97a2008091ee04fbbb4/) Universal Health Services · RENO, Nevada ### [Corporate MD Grievance & Appeals](https://jobs.opennash.com/companies/humana/jobs/aae148c0c62b428aeba6/) Humana · Remote, Nationwide, United States of America ### [Lead Quality Risk Management - Grievance/Appeals](https://jobs.opennash.com/companies/universal-health-services/jobs/680edc47746d17a200e0/) Universal Health Services · RIVERSIDE, California ### [Manager II Medical Management, Grievance and Appeals CA RN required](https://jobs.opennash.com/companies/elevance-health/jobs/fd5378534feb53b88f8a/) Elevance Health · California - Woodland Hills +4 more ### [Medical Review Nurse (RN)- Post Appeals (must be licensed in Illinois)](https://jobs.opennash.com/companies/molina-healthcare/jobs/ce11d571e4e15a9d9c18/) Molina Healthcare · United States OpenNash lists jobs from employers’ own careers sites and does not handle applications. Dates come from the employer where stated; “first seen” and “last checked” are our own observations. [ OpenNash ](https://opennash.com/) AI-native services firm that builds custom software and 24/7 AI agents. OpenNash Jobs is an OpenNash Applied AI project. [Book time with OpenNash](https://calendly.com/opennash/new-meeting?hide_gdpr_banner=1) Jobs - [Search jobs](https://jobs.opennash.com/search/) - [Companies](https://jobs.opennash.com/explore/) - [Hiring report](https://jobs.opennash.com/reports/hiring/) - [AI assistants](https://jobs.opennash.com/connect/) - [How it works](https://jobs.opennash.com/methodology/) OpenNash - [opennash.com](https://opennash.com/) - [Services](https://opennash.com/ai-agent-consulting/) - [OpenNash CX](https://opennash.com/cx/) - [AI Tools](https://opennash.com/ai-tools/) - [Blog](https://opennash.com/blog/) - [About](https://opennash.com/about/) Contact - [hello@opennash.com](mailto:hello@opennash.com) - [LinkedIn](https://www.linkedin.com/company/opennash) - [Support](https://jobs.opennash.com/support/) - [Privacy](https://jobs.opennash.com/privacy/) - [Terms](https://jobs.opennash.com/terms/) © 2026 OpenNash, Inc. Company names and public job postings belong to their respective owners. Employers control source availability and application decisions.