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Nurse Grievance and Appeals Salary
in Maine, United States

$79,239 (USD)

Average Salary

$38/hr

Average Hourly

$1,387

Average Bonus

Salary Recap

The average pay for a Nurse Grievance and Appeals is $79,239 a year and $38 an hour in Maine, United States. The average salary range for a Nurse Grievance and Appeals is between $55,300 and $98,508. This compensation analysis is based on salary survey data collected directly from employers and anonymous employees in Maine, 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:
$91,860
5 Year Change:
16 %

Education

Education data not available for this job

Skills

Skills data not available for this job

Nurse Grievance and Appeals Job Listings for Maine, United States

No listings found
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