RN Clinical Grievance Analyst

Strategic Staffing Solutions; Michigan; Remote; Full time

Job summary

A leading health care provider is seeking a Registered Nurse to provide clinical support for grievances in Michigan. The role involves analyzing and resolving sensitive inquiries, documenting findings, and supporting claim adjudication. Ideal candidates will have strong clinical experience and knowledge of medical terminology. This is a contract position with potential for permanent placement.

Qualifications

• 2-5 years of clinical patient care experience required.
• Expertise in medical terminology and clinical documentation preferred.

Responsibilities

• Provide clinical support to grievances and analyze sensitive inquiries.
• Document findings and advise for claim adjudication.

Skills

Grievance and Appeals

Medical terminology

Clinical documentation

Computer Skills

Education

Registered Nurse with current Michigan license

Job description

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Strategic Staffing Solutions provided pay range

This range is provided by Strategic Staffing Solutions. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$34.00/hr - $36.00/hr

Direct message the job poster from Strategic Staffing Solutions

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

Duration: 12+ Months with potential for permanent

Role Type: W2 Contract Engagement

Pay Rate: $34-36/HR

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 to five (2-5) years of 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.
• 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 25-30 WPM or greater.

Seniority level

• Mid-Senior level

Employment type

• Contract

Job function

• Health Care Provider
• Industries: Hospitals and Health Care