Appeals And Grievances Nurse

621

Somerville, MA, United States
Base: $63,648.00 - $90,750.40 annually; bonus/equi...
**
Massachusetts registered nurse license required
3-5 years clinical appeals experience
2-3 years clinical experience required
** Mass General Brigham is seeking an Appeals and Grievances Nurse to join their remote team in Somerville, MA. The role involves reviewing clinical and pharmacy appeals, ensuring compliance with regulatory standards, and collaborating with healthcare professionals to enhance patient care. **

Job Summary

  • The role ensures clinical and pharmacy appeal cases meet contractual, regulatory, and business goals within a leading integrated healthcare system.
  • Employees collaborate with medical directors, providers, and members to resolve complex clinical issues and ensure timely grievance resolution.
  • The position offers competitive salaries, flexible work options, and career growth opportunities within a supportive environment at Mass General Brigham.

Matching Summary

Match Score: 75

** Mass General Brigham is seeking an Appeals and Grievances Nurse to join their remote team in Somerville, MA. The role involves reviewing clinical and pharmacy appeals, ensuring compliance with regulatory standards, and collaborating with healthcare professionals to enhance patient care. **

Salary

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

Skills & Requirements

Must-have

  • Massachusetts Registered Nurse license required
  • 3-5 years clinical appeals experience
  • 2-3 years clinical experience required
  • Electronic health records proficiency
  • Regulatory timeframe adherence

Nice-to-have

  • Strong analytical and critical thinking skills
  • Excellent verbal and written communication
  • Interdisciplinary meeting participation
  • Quality improvement initiative identification
  • Sensitive information confidentiality

Key Requirements

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

Work Rights

Not specified

Tailored Resume

Cover Letter