RN Clinical Grievances - Behavioral Health

Job Summary

Working remotely in a full-time capacity, the Clinical Grievances RN - Behavioral Health will review member cases for appropriate care, facilitate discussions with healthcare providers, and uphold quality service standards while collaborating with medical directors and non-clinical partners.

Key responsibilities:

• Perform clinical assessments of healthcare services for appropriateness
• Understand and apply state and federal grievance and peer review requirements
• Facilitate telephonic discussions to gather additional clinical information

Required qualifications:

• Current, unrestricted RN license in the state of residency
• Experience working in the Behavioral Health field as an RN
• 3+ years of total RN experience, including inpatient/acute clinical experience
• Demonstrated clinical documentation and critical thinking skills
• Proficiency in computer skills, including Microsoft Suite and clinical platforms