Appeals And Grievances Nurse

Brigham and Women's Faulkner Hospital

Somerville, MA, United States
Base: $63,648.00 - $90,750.40/annual; bonus/equity...
Fully remote
Clinical appeal case reviews
Regulatory timeframe adherence
Provider and member interaction
The role ensures clinical and pharmacy appeal cases are resolved timely to meet strict regulatory timeframes while collaborating with medical directors

Job Summary

  • The role ensures clinical and pharmacy appeal cases are resolved timely to meet strict regulatory timeframes while collaborating with medical directors.
  • Employees interact directly with providers, members, and advocates to gather clinical information and resolve complex health issues.
  • The position offers a competitive salary range of $63,648.00 to $90,750.40 annually along with comprehensive benefits and flexible work options.

Matching Summary

The role ensures clinical and pharmacy appeal cases are resolved timely to meet strict regulatory timeframes while collaborating with medical directors.

Salary

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

Skills & Requirements

Must-have

  • Clinical appeal case reviews
  • Regulatory timeframe adherence
  • Provider and member interaction
  • Electronic health records proficiency
  • Massachusetts RN license required

Nice-to-have

  • Strong analytical critical thinking skills
  • Interdisciplinary meeting participation
  • Trend identification for quality improvement
  • Patient education capabilities
  • Flexible remote work environment

Key Requirements

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

Work Rights

Not specified

Tailored Resume

Cover Letter