RN Clinical Grievances Nurse

Job Summary

Reviewing incoming member cases for care appropriateness, the full-time RN Clinical Grievances Nurse will work remotely within the PST, MST, or CST time zones, conducting clinical assessments and facilitating discussions with healthcare providers and members.

Key responsibilities:

• Perform clinical assessments of healthcare services provided to members
• Facilitate telephonic discussions with healthcare providers and members to gather clinical information
• Manage and maintain quality and productivity metrics while working independently and collaboratively with Medical Directors and non-clinical partners

Required qualifications:

• Current, unrestricted RN license in the state of residency
• 3+ years of total RN experience, including clinical experience in an inpatient/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 at home