To support the Appeals and Grievance review process, the full-time Massachusetts Licensed Clinical Nurse will ensure timely resolution of clinical and pharmacy appeal cases, collaborating with various healthcare teams in a remote work environment. Key responsibilities Ensure timely resolution of clinical/pharmacy appeals and grievances in compliance with regulatory timeframes Interact with providers and members to gather clinical information and understand the intent of appeals or grievances Review appeal cases and provide recommendations to the medical director based on clinical analysis Required qualifications Bachelor's Degree required Massachusetts Registered Nurse (RN) license required 3-5 years of experience in clinical appeals, grievances, or utilization review required 2-3 years of clinical experience required Strong analytical and critical thinking skills
Massachusetts Licensed Clinical Nurse in workfromhome at Unknown Company
This position is listed as full time and able to be worked remotely.