Mass General Brigham is seeking a Senior Nurse External Appeal Reviewer to facilitate clinical charge audits and appeal processes in a fully remote position. The ideal candidate should have a nursing background with experience in quality assurance and strong analytical skills
Job Summary
The Senior Nurse Reviewer plays a critical role in appealing challenges to charging policy and practice to support Mass General Brigham's net revenue.
This position requires coordinating audits with external third-party representatives and preparing detailed packages for complex forensic review findings.
Candidates must possess strong appeal writing experience to successfully defend clinical charge audit findings during the appeals process.
Matching Summary
Match Score: 85
Mass General Brigham is seeking a Senior Nurse External Appeal Reviewer to facilitate clinical charge audits and appeal processes in a fully remote position. The ideal candidate should have a nursing background with experience in quality assurance and strong analytical skills.
Salary
Base: $79,560.00 - $115,720.80 annually; Bonus/Equity: Not specified; Benefits: Comprehensive benefits, career advancement, differentials, premiums, and bonuses included
Skills & Requirements
Must-have
Strong appeal writing experience
Clinical data interpretation skills
Electronic health record proficiency
Multidisciplinary team collaboration
Nice-to-have
Ability to provide constructive feedback
Facilitate training for nursing staff
Excellent communication skills
Strong organizational attention to detail
Key Requirements
Bachelor's Degree in Nursing
Active RN license in Massachusetts
3+ years clinical nursing experience
2+ years quality assurance or clinical review experience