Massachusetts Licensed Clinical Nurse

A company is looking for a Clinical Appeals and Grievances Nurse. Key Responsibilities Ensure timely resolution of clinical / pharmacy appeals and grievances to meet regulatory timeframes Review clinical / pharmacy appeal cases and provide recommendations to the medical director team Interact with providers and members to gather clinical information and understand the intent of appeals Required Qualifications Bachelor's Degree in Healthcare Administration, Nursing, or a related field required Massachusetts Registered Nurse (RN) license required 3-5 years of experience in clinical appeals, grievances, or related healthcare services required 2-3 years of clinical experience required Experience with Medicare Advantage appeals preferred