Clinical Appeal And Grievance 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
Interact with providers and members
Analyze clinical material
Mass General Brigham Health Plan is at the forefront of transformation within one of the world’s leading integrated healthcare systems, providing innovative solutions centered on member health needs

Job Summary

  • Mass General Brigham Health Plan is at the forefront of transformation within one of the world’s leading integrated healthcare systems, providing innovative solutions centered on member health needs.
  • The Clinical Appeal And Grievance Nurse ensures clinical/pharmacy appeal case reviews meet contractual, regulatory, and business goals, collaborating with various teams to resolve clinical issues.
  • The organization offers competitive salaries, a comprehensive benefits package, flexible work options, and career growth opportunities within a welcoming and supportive environment.

Matching Summary

Mass General Brigham Health Plan is at the forefront of transformation within one of the world’s leading integrated healthcare systems, providing innovative solutions centered on member health needs.

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
  • Interact with providers and members
  • Analyze clinical material
  • Maintain compliance with turnaround times
  • NCQA requirements knowledge

Nice-to-have

  • Exceptional member experience focus
  • Collaborative team environment
  • Continuous learning opportunities
  • Adaptable to change

Key Requirements

  • Bachelor's Degree required
  • Massachusetts Registered Nurse (RN) required
  • 3-5 years clinical appeals experience
  • 2-3 years clinical experience

Work Rights

Not specified

Tailored Resume

Cover Letter