Teams at Mass General Brigham

Reviews clinical and pharmacy appeals and grievances, analyzes clinical documentation, recommends resolutions to medical directors, obtains information from providers and members, coordinates specialty reviews, and prepares written case summaries. The role ensures regulatory, contractual, NCQA, and turnaround-time compliance while collaborating with appeal, grievance, pharmacy, and medical director teams.

Provides direct post-anesthesia nursing care, assesses patients, administers medications, monitors vital signs and condition changes, maintains clinical records, collaborates with healthcare teams, and adjusts care plans based on patient needs. The role requires an active RN license, BLS certification, and three to five years of clinical nursing experience in an ER, ICU, or PACU. ACLS, NRP, and PALS certifications are preferred.

Manages hospital capacity and patient access by coordinating incoming transfers and referrals, triaging patients, facilitating timely placement, and reducing transfer delays. Conducts nursing assessments, collaborates with providers and support staff, supports continuity of care, and documents visits, testing, referrals, and medications. Requires Massachusetts RN licensure, a bachelor’s degree in nursing, clinical nursing experience, and Level I emergency department or ICU experience.