Contract
RN Clinical Grievance Analyst
Posted on 18 March 25 by Christine Slater
- Detroit, MI
- $ - $
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Job Description
STRATEGIC STAFFING SOLUTIONS (S3) HAS AN OPENING!
Strategic Staffing Solutions is currently looking for an RN Clinical Grievance Analyst for a contract opportunity with one of our largest clients located in Detroit, MI!
Title: RN Clinical Grievance Analyst
Location: Detroit, MI (Remote - must be local to Michigan)
Duration: 12+ Months
Role Type: W2 Contract Engagement
Pay Rate: 34/HR With health benefits
Pay rate: 36/HR without Health Benefits.
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.
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.
- Associate Degree in Nursing or Nursing diploma required. BSN preferred.
- 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.