Clinical Appeal and Grievance Nurse
Brigham and Women(1 month ago)
About this role
The role is a clinical appeals position within a health plan responsible for supporting the Appeals and Grievance process by evaluating clinical and pharmacy cases and coordinating with clinical leadership. The position works with internal teams, providers, and members to ensure reviews meet contractual, regulatory, and business expectations while supporting quality and compliance goals.
Required Skills
- Clinical Review
- Pharmacy Review
- Utilization Review
- Regulatory Compliance
- Provider Communication
- Case Analysis
- EHR
- InterQual Criteria
- Medicare Knowledge
- Documentation
Qualifications
- Bachelor's Degree
- Massachusetts Registered Nurse (RN)
About Brigham and Women
brighamandwomens.orgBrigham and Women’s Hospital is one of the top hospitals in America with more than 790 beds, and a premier teaching hospital of Harvard Medical School. Learn more.
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