Massachusetts Licensed Clinical Nurse - job 2 of 2

Job Summary

A company is looking for a Clinical Appeal and Grievance Nurse, part-time.

Key Responsibilities

• Ensure timely resolution of clinical/pharmacy appeals and grievances to meet regulatory timeframes
• Interact with providers and members to gather clinical information and understand appeals
• Review clinical/pharmacy appeal cases and provide recommendations to the medical director team

Required Qualifications

• Bachelor's Degree required
• Massachusetts Registered Nurse (RN) required
• 3-5 years of experience in clinical appeals, grievances, or related healthcare services required
• 2-3 years of clinical experience required
• Experience with multiple data systems preferred