--- title: Grievance & Appeals Specialist, Clinical RN description: VNS Health is hiring for the Grievance & Appeals Specialist, Clinical RN role in New York, NY. See the full description and apply. type: job url: https://www.foundrole.com/jobs/grievance-and-appeals-specialist-clinical-rn-at-vns-health-01a1c156-557b-790b-98c3-3d91f782db0c date: 2026-11-15T01:26:44Z og_description: Join VNS Health as Grievance & Appeals Specialist, Clinical RN in New York, NY. Pays $93.4K–$116.8K per year. Full-time role. og_image: https://www.foundrole.com/og/qdpicl.png breadcrumbs: - label: Home url: https://www.foundrole.com/ - label: Search url: https://www.foundrole.com/jobs --- | | | |---|---| | **Company** | [VNS Health](https://www.foundrole.com/companies/vns-health?utm_source=ai_markdown) | | **Location** | New York, NY | | **Salary** | $93.4K/yr - $116.8K/yr | | **Type** | Full Time | | **Posted** | Nov 10, 2026 | ## Is this job real? **Ghost job check:** A · Low risk. Probably a real opening. ## Visa sponsorship - **H-1B:** VNS Health sponsors H-1B visas. It filed 9 H-1B petitions (FY2026 Q1 – FY2026 Q4). - **E-Verify:** No E-Verify enrollment on record for VNS Health. ## Pay for similar jobs Most similar jobs pay $81,000 – $162,000 a year (median $105,000). ## Description **Overview** Resolves grievances, appeals and external reviews for one of the following VNS Health Plans product lines – Managed Long Term Care (MLTC), Medicare Advantage (MA), or Select Health. Ensures regulatory compliance, timeliness requirements and accuracy standards are met. Coordinates efficient functioning of day-to-day operations according to defined processes and procedures. Creates and maintains accurate records documenting the actions and rationale for each grievance or appeal decision. Develops correspondence communicating the outcome of grievances and appeals to enrollees and/or providers. Assists with collecting and reporting data. Works under general supervision. **Grievance and appeals experience required.** **What We Provide** - Referral bonus opportunities - Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays - Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability - Employer-matched retirement saving funds - Personal and financial wellness programs - Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care - Generous tuition reimbursement for qualifying degrees - Opportunities for professional growth and career advancement - Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities   **What You Will Do**  - Develops and maintains current knowledge of state and federal regulatory requirements related to all aspects of grievances and appeals for Medicare managed care organizations, Medicaid, home health care, managed long term care as well as contractual requirements. - Investigates and reviews routine and complex situations and underlying issues, analyzes and solves problems, focusing primarily on issues of medical necessity, quality of care, long term services and supports, etc.. Consults with the member, family, providers and health plan departments as necessary. Identifies and communicates key points from details. - Investigates and coordinates the resolution of routine and complex grievances and appeals according to defined processes and procedures ensuring that required timeframes and regulatory requirements are met, accurate and timely follow up is completed and activities are documented as required. - Reviews covered and coordinated services in accordance with established plan benefits, application of medical criteria and regulatory requirements to ensure appropriate appeal resolution and execution of the plan’s fiduciary responsibilities. Prepares records for physician review as needed. - Conducts review of requests for prior authorization of health services, as required in certain product lines, and prepares written responses consistent with regulatory requirements. - Coordinates external case reviews requested by enrollees, including preparing and submitting documentation according to regulatory requirements and tracking external reviews throughout the process. External reviewers include New York State (Fair Hearings), Centers for Medicare and Medicaid Services (CMS), Independent Review Entities and Quality Improvement Organizations. - Collaborates with professionals, health plan departments such as Claims and Medical Management, and the third party administrator staff and legal, as necessary, to investigate and facilitate resolution of individual grievances and appeals. Consults with enrollees, providers and the Medical Director, as appropriate. - Provides input and recommendations for design and development of policies, processes and procedures for improved department operations and customer service. - Reviews information available from Medicaid, Medicare, other payers, and/or professional medical organizations regarding benefit levels and medical necessity criteria. - Enters data and assists with compiling reports and analysis on the grievance and appeals process. - Participates in special projects and performs other duties as assigned. **Qualifications** **Licenses and Certifications:** License and current registration to practice as a registered professional nurse in New York State required **Education:** Bachelor's Degree or Master’s Degree in Nursing preferred **Work Experience:** Minimum three years progressive professional experience in health care, including a minimum of two years in a grievance and appeals or related area such as medical or utilization management requiredProficient verbal/written communication skills requiredProficient computer and typing skills and knowledge of Microsoft Office (Word and Excel) requiredAbility to work in a fast paced environment and effectively manage multiple grievances and appeals simultaneously. **Pay Range** USD $93,400.00 - USD $116,800.00 /Yr. **About Us** VNS Health has been committed to meeting the needs of New Yorkers for over 130 years. We’re one of the largest nonprofit home- and community-based health care organizations in the country, and today, more than 11,500 team members work together to make a difference in the lives of more than 99,000 patients and members on any given day. ## Skills - Utilization Management - Grievance Handling - Microsoft Excel - Managed Care - Home Health Care - Typing - Quality of Care - Microsoft Word - Quality Improvement - Prior Authorization - Appeals - Long-Term Care - Content Management System (Cms) - Medicare - Referral Processing - Microsoft Office - Litigation - Human Resources - Written Communication - Communication - Medical Necessity - Equities - Medical Management - Customer Service - Medicaid - Regulatory Compliance ## Benefits - Financial Aid/Assistance - Health and Wellness Programs - Health Insurance - Dental Insurance - Vision Insurance - Disability Insurance - Life Insurance - Paid Time Off (Pto) ## Related - [More jobs at VNS Health](https://www.foundrole.com/companies/vns-health?utm_source=ai_markdown) - [Healthcare & Medicine jobs](https://www.foundrole.com/careers/healthcare-and-medicine?utm_source=ai_markdown)- [Healthcare Administration jobs](https://www.foundrole.com/careers/healthcare-and-medicine/healthcare-administration?utm_source=ai_markdown)- [Utilization Review Nurse jobs](https://www.foundrole.com/careers/healthcare-and-medicine/healthcare-administration/utilization-review-nurse?utm_source=ai_markdown)- [Browse all companies](https://www.foundrole.com/companies?utm_source=ai_markdown) ## Explore this job market - [New York](https://www.foundrole.com/locations/us/new-york?utm_source=ai_markdown) — 150100 jobs - [New York, NY](https://www.foundrole.com/locations/us/new-york/new-york?utm_source=ai_markdown) — 66065 jobs - [Home Health Care Services](https://www.foundrole.com/sectors/healthcare/home-health-care-services?utm_source=ai_markdown) — 50096 jobs - [VNS Health](https://www.foundrole.com/companies/vns-health?utm_source=ai_markdown) — 145 jobs ## Related pages - [New York](https://www.foundrole.com/locations/us/new-york?utm_source=ai_markdown) — 150100 jobs - [New York, NY](https://www.foundrole.com/locations/us/new-york/new-york?utm_source=ai_markdown) — 66065 jobs - [Home Health Care Services](https://www.foundrole.com/sectors/healthcare/home-health-care-services?utm_source=ai_markdown) — 50096 jobs - [VNS Health](https://www.foundrole.com/companies/vns-health?utm_source=ai_markdown) — 145 jobs ## Browse - [Companies](https://www.foundrole.com/companies?utm_source=ai_markdown) - [Jobs by country](https://www.foundrole.com/locations?utm_source=ai_markdown) - [Jobs in the United States by state and city](https://www.foundrole.com/locations/us?utm_source=ai_markdown) - [H1B sponsors by location](https://www.foundrole.com/h1b-sponsors?utm_source=ai_markdown) - [H1B salaries](https://www.foundrole.com/h1b-salaries?utm_source=ai_markdown) - [Sectors and industries](https://www.foundrole.com/sectors?utm_source=ai_markdown) - [Jobs by career field](https://www.foundrole.com/careers?utm_source=ai_markdown) - [Latest jobs](https://www.foundrole.com/jobs/latest?utm_source=ai_markdown)