Appeals And Grievances Nurse

Mass General Brigham Health Plan Holding Company, Inc.

Somerville, MA, United States
Base: $63,648.00 - $90,750.40/annual; bonus/equity...
Fully remote
Clinical/pharmacy appeal case reviews
Resolve clinical issues
Obtain additional clinical information
The role is an integral part of our Appeals and Grievance review process and will ensure clinical/pharmacy appeal case reviews meet contractual, regulatory, and business goals

Job Summary

  • The role is an integral part of our Appeals and Grievance review process and will ensure clinical/pharmacy appeal case reviews meet contractual, regulatory, and business goals.
  • This position collaborates with members of the Appeal and Grievance team, pharmacy team, and medical director teams to resolve all types of clinical issues across the clinical/pharmacy appeal landscape.
  • We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more.

Matching Summary

The role is an integral part of our Appeals and Grievance review process and will ensure clinical/pharmacy appeal case reviews meet contractual, regulatory, and business goals.

Salary

Base: $63,648.00 - $90,750.40/Annual; Bonus/Equity: Not specified; Benefits: comprehensive benefits package

Skills & Requirements

Must-have

  • clinical/pharmacy appeal case reviews
  • resolve clinical issues
  • obtain additional clinical information
  • analyze clinical material
  • track and monitor status

Nice-to-have

  • exceptional member experience
  • transformative healthcare
  • welcoming and supportive environment

Key Requirements

  • Bachelor's Degree in Nursing
  • Massachusetts RN License
  • 3-5 years clinical appeals/grievances experience
  • 2-3 years clinical experience

Work Rights

Not specified

Tailored Resume

Cover Letter