Strategic Staffing Solutions
Title: RN Clinical Grievance Analyst
Location: Detroit, MI (Remote – must be local to Michigan)
Duration: 12+ Months
Role Type: W2 Contract Engagement
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.
- 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-241579
Publish Date: 15 May 2025