Appeals And Grievances Nurse

Mass General Brigham Health Plan Holding Company, Inc.

Somerville, Massachusetts, United States
Base: $63,648.00 - $90,750.40/annual; bonus/equity...
Fully remote
Massachusetts registered nurse license required
3-5 years clinical appeals experience
Review clinical appeal cases
The role is an integral part of the Appeals and Grievance review process ensuring clinical cases meet contractual and regulatory goals

Job Summary

  • The role is an integral part of the Appeals and Grievance review process ensuring clinical cases meet contractual and regulatory 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 healthcare environment.

Matching Summary

The role is an integral part of the Appeals and Grievance review process ensuring clinical cases meet contractual and regulatory goals.

Salary

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

Skills & Requirements

Must-have

  • Massachusetts Registered Nurse license required
  • 3-5 years clinical appeals experience
  • Review clinical appeal cases
  • Interact with providers and members
  • Analyze clinical material for validity

Nice-to-have

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

Key Requirements

  • Bachelor's Degree in Nursing required
  • Massachusetts RN License required
  • 3-5 years experience in clinical appeals or utilization review
  • 2-3 years clinical experience required

Work Rights

Not specified

Tailored Resume

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