Offer summary

Qualifications:

Registered Nurse with a current Michigan license required., Associate Degree in Nursing or Nursing diploma required; BSN preferred., 2-5 years of clinical patient care experience, including LPN and RN., Strong knowledge of medical terminology and clinical documentation is preferred..

Key responsabilities:

Provide clinical support to grievances and analyze sensitive inquiries and complaints.

Document findings and render decisions within the system for claim adjudication.

Construct write-ups for denials, detailing findings and supporting documentation for medical consultant analysis.

Utilize computer skills to navigate data entry systems and manage multiple tasks.

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: 32/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

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.
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.
Beware of scams. S3 never asks for money during its onboarding process

Job ID: JOB-240744

Publish Date: 18 Mar 2025

Tagged as: RN Clinical Grievance Analyst

Required profile