Registered Nurse- Clinical Grievance Analyst

Strategic Staffing Solutions; Detroit (MI); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading healthcare provider is seeking a Registered Nurse for the role of Clinical Grievance Analyst in Detroit, MI. This opportunity involves analyzing and resolving member grievances while ensuring compliance with policies. Ideal candidates will have a valid Michigan RN license, clinical experience, and strong skills in medical terminology.

Qualifications

• 2-5 years clinical patient care experience.
• Knowledge of Medicare Benefit Policy, with some medical coding helpful.

Responsibilities

• Provide Clinical support to all grievances.
• Analyze, investigate, resolve and respond to sensitive inquiries.

Skills

Clinical documentation

Medical terminology

Strong Computer Skills

Education

Registered Nurse with current Michigan license

Job description

Registered Nurse- Clinical Grievance Analyst

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Title: RN Clinical Grievance Analyst

Location: Detroit, MI (Remote - must be local to Michigan)

Duration: 12+ Months

Role Type: W2 Contract Engagement

Max Rate: 36/HR with no benefits

34/HR with health

Schedule: Monday - Friday, 40/HR week

Must have:

• Previous experience with Grievance and Appeals
• Knowledge of Benefit policies/guidelines
• Medical terminology
• Clinical documentation
• Interqual experience a bonus
• Must have strong Computer Skills
• Registered Nurse with current Michigan license required.

Job Description:

Provide Clinical support to all grievances. Analyze, investigate, resolve and respond to highly confidential/sensitive inquiries and complaints received through the formal member grievance process. Responsible for rendering a decision documenting findings within the system and advising the findings to allow for claim adjudication. If a decision can’t be concluded or the findings result in a denial the RN Review Analyst will be instrumental in constructing a write up that is required for evaluation, describing the current findings along with the supporting documentation for medical consultant analysis.

Requirements:

• Registered Nurse with current Michigan license required.
• Two-five (2-5) years clinical patient care experience; can include LPN and RN patient care combined.
• Med/Surg, acute care, home care and/or rehabilitation clinical experience.
• Expertise in the use of medical terminology and clinical documentation preferred.
• MDS, case management and utilization review experience highly beneficial.
• Good computer and multi-task abilities; able to navigate through data entry systems.
• Must have knowledge of Medicare Benefit Policy, medical terminology with some medical coding highly helpful.
• Ability to navigate between screens for inputting and pulling data is required.
• Able to type between 25-30WPM or greater.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Contract

Job function

• Job function

  Research

• Industries

  Hospitals and Health Care

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