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 appeal case reviews
Regulatory compliance
Provider interaction
Mass General Brigham Health Plan is at the forefront of transformation with 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 with 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 with 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 appeal case reviews
  • Regulatory compliance
  • Provider interaction
  • Member interaction
  • Clinical material analysis

Nice-to-have

  • Exceptional member experience
  • Groundbreaking medical discoveries
  • Welcoming and supportive environment
  • Flexible work options
  • Career growth opportunities

Key Requirements

  • Bachelor's Degree required
  • Massachusetts Registered Nurse (RN) required
  • 3-5 years clinical appeals experience
  • 2-3 years clinical experience
  • Proficient in EHR and billing systems

Work Rights

Not specified

Tailored Resume

Cover Letter