Arizona Licensed Clinical Grievances RN

Job Summary

Working remotely and available for PST hours, the Arizona Licensed Clinical Grievances RN will review incoming retrospective cases and current member needs, ensuring appropriate care is provided while managing clinical assessments and documentation.

Key responsibilities

• Perform clinical assessments of healthcare services for appropriateness and compliance with grievance and peer review standards
• Document case reviews, providing rationale for severity levels and any Improvement Action Plans (IAP) implemented
• Facilitate discussions with healthcare providers and members to gather additional clinical information as needed

Required qualifications

• Current, unrestricted RN license in the state of residency
• 3+ years of RN experience, including recent clinical experience in an inpatient or acute setting
• Demonstrated clinical documentation and critical thinking skills
• Proficiency in computer skills, including Microsoft Suite and clinical platforms
• Designated workspace with secure high-speed internet access