Job Details

Appeals & Grievances Case Manager (Oregon)

Immediate need for a talented Appeals & Grievances Case Manager in Oregon (Remote). This is a 06+ months contract opportunity with long-term potential. Please review the job description below and contact me ASAP if you are interested. Job ID:26-28397 Pay Range: $27 - $30/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 or Care Coordination in a health plan or TPA.
• Strong understanding of CMS, DMHC, and NCQA regulatory standards.
• 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 Biopharmaceutical 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.