Strategic Staffing Solutions
STRATEGIC STAFFING SOLUTIONS (S3) HAS AN OPENING!
Strategic Staffing Solutions is currently looking for an RN Clinical Grievance Coordinator for a contract opportunity with one of our largest clients located in Detroit, MI!
Title: RN Clinical Grievance Coordinator
Location: Detroit, MI – Remote/Must reside in 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
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.
- MUST HAVE STRONG COMPUTER SKILLS.
The S3 Difference
The global mission of S3 is to build trusting relationships and deliver solutions that positively impact our customers, our consultants, and our communities. The four pillars of our company are to:
- Set the bar high for what a company should do
- Create jobs
- Offer people an opportunity to succeed and change their station in life
- Improve the communities where we live and work through volunteering and charitable giving
As an S3 employee, you’re eligible for a full benefits package that may include:
- Medical Insurance
- Dental Insurance
- Vision Insurance
- 401(k) Plan
- Vacation Package
- Life & Disability Insurance Plans
- Flexible Spending Accounts
- Tuition Reimbursement
Job ID: JOB-218909
Publish Date: 09 Feb 2023