Appeals And Grievances Nurse

Mass General Brigham Health Plan Holding Company, Inc.

Somerville, Massachusetts, United States
Base: $63,648.00 - $90,750.40 annually; bonus/equi...
Fully remote
Massachusetts registered nurse license required
3-5 years clinical appeals experience
2-3 years clinical experience required
The role ensures clinical and pharmacy appeal case reviews meet contractual, regulatory, and business goals

Job Summary

  • The role ensures clinical and pharmacy appeal case reviews meet contractual, regulatory, and business goals.
  • Employees collaborate with medical directors and pharmacy teams to resolve complex clinical issues across the appeal landscape.
  • The position offers competitive salaries, flexible work options, and career growth opportunities within a welcoming environment.

Matching Summary

The role ensures clinical and pharmacy appeal case reviews meet contractual, regulatory, and business goals.

Salary

Base: $63,648.00 - $90,750.40 annually; Bonus/Equity: Not specified; Benefits: Comprehensive benefits package included

Skills & Requirements

Must-have

  • Massachusetts Registered Nurse license required
  • 3-5 years clinical appeals experience
  • 2-3 years clinical experience required
  • Review clinical pharmacy appeal cases
  • Resolve appeals within regulatory timeframes

Nice-to-have

  • Strong analytical and critical thinking skills
  • Excellent verbal and written communication abilities
  • Proficient in electronic health records systems
  • Detail-oriented with strong organizational skills
  • Ability to handle sensitive information confidentially

Key Requirements

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

Work Rights

Not specified

Tailored Resume

Cover Letter