Massachusetts Licensed Clinical Nurse

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

Jun 21, 2025 - 09:50

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