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Grievance and Appeals Nurse Salary
in Delaware, United States

$87,136 (USD)

Average Salary

$42/hr

Average Hourly

$1,525

Average Bonus

Salary Recap

The average pay for a Grievance and Appeals Nurse is $87,136 a year and $42 an hour in Delaware, United States. The average salary range for a Grievance and Appeals Nurse is between $60,811 and $108,325. This compensation analysis is based on salary survey data collected directly from employers and anonymous employees in Delaware, United States.

Average Salary Chart

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Job Summary

Description:
  • Evaluates and resolves clinical appeals, grievances, and external reviews received from members or providers, including review of pre-service and post-service appeals, utilizing understanding of clinical department operations and claims processing procedures.
  • Communicates and interacts with external partners, including providers, medical groups, Independent Practice Associations, and other external vendors.
  • Reviews medical records related to grievances and appeals, provides monitoring of cases involving medical decisions and quality or care or service, and prepares and performs clinical reviews.
  • Logs grievances and appeals; obtains medical records as needed; and provides clinical reviews, write-ups, and recommendations.
  • Develops correspondence communicating acknowledgement and resolution to enrollees and providers, following appeal time frames.
  • Requires RN license.

Salary Potential

Estimated salary in 2023:
$101,015
5 Year Change:
16 %

Education

Education data not available for this job

Skills

Skills data not available for this job

Grievance and Appeals Nurse Job Listings for Delaware, United States

No listings found
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