Registered Nurse - Grievance and Appeals

MEDIKO INC • Harrisburg, PA

2d • Onsite

About The Position

MEDIKO: Mission driven & committed to delivering high-quality medical care to the communities we serve. Our dedicated Healthcare Professionals find meaning, support and new opportunities to learn and grow their skills every day. It’s what sets us apart from other healthcare industries and drives our success in the correctional healthcare space. Whether you are just graduating from nursing school or bringing years of experience to your new position at MEDIKO, you will benefit from our competitive compensation, commitment to safety and exposure to the diverse healthcare needs of the clients we serve. If you’re ready to take on a role that will enrich your career and make a real impact to your community, we encourage you to APPLY TODAY to get the conversation started! The Registered Nurse - Grievance and Appeals is responsible for the review, investigation, and resolution of patient grievances, complaints, and clinical appeals related to healthcare services provided within MEDIKO correctional facilities. This role ensures that all grievances and appeals are addressed in accordance with contractual obligations, regulatory requirements, accreditation standards, and internal policies. The Registered Nurse - Grievance and Appeals serves as a clinical resource supporting timely, thorough, and compliant grievance resolution processes while identifying trends and opportunities for system improvement. This position collaborates closely with facility leadership, medical providers, quality teams, and corporate leadership to ensure appropriate clinical review and response.

Requirements

• A current, valid state(s) licensure, certificate and/or credentials documenting ability to practice in applicable role (i.e. CMA, LPN, RN, LMHP, etc.).
• A High School diploma or GED is required.
• 1-3 years of experience in a healthcare setting, preferably in a correctional healthcare or similar environment.
• Experience in roles that involve direct patient care or administrative support in a regulated environment is preferred.
• Strong understanding of healthcare regulations, policies, and procedures as they relate to the correctional setting is an advantage.
• Demonstrated ability to manage time effectively, adhere to protocols, and deliver high-quality service in a fast-paced, structured environment.
• Active CPR/BLS certificate required (American Heart Association/American Red Cross guideline approved).

Nice To Haves

• An Associate’s or Bachelor's degree in Healthcare, Nursing, or a related field is preferred but not required.

Responsibilities

• Grievance and Complaint Management Review, investigate, and resolve inmate/patient grievances related to healthcare services in accordance with established policies and contractual timelines.
• Conduct clinical assessments of complaints to determine appropriateness of care, adherence to standards, and required follow-up actions.
• Coordinate with facility clinical leadership, including Health Services Administrators, Directors of Nursing, and providers, to gather information related to grievances.
• Ensure timely and accurate documentation of grievance investigations and responses.
• Clinical Appeals Review Conduct clinical review of healthcare appeals related to treatment decisions, medication management, specialty referrals, and other medical services.
• Evaluate appeals against applicable clinical guidelines, policies, and standards of care.
• Collaborate with medical leadership to determine appropriate clinical determinations and responses.
• Prepare written appeal determinations that clearly explain clinical reasoning and outcomes.
• Compliance and Regulatory Oversight Ensure grievance and appeals processes comply with applicable regulations, accreditation standards, and contractual requirements.
• Monitor response timelines and ensure compliance with grievance response requirements.
• Maintain documentation necessary for audits, inspections, and accreditation reviews.
• Quality Improvement and Reporting Track and analyze grievance and appeals trends across facilities to identify systemic issues or opportunities for improvement.
• Prepare periodic reports for clinical leadership and compliance teams outlining trends, response metrics, and recommendations.
• Partner with operational and clinical leadership to implement corrective actions where appropriate.
• Collaboration and Support Serve as a clinical resource to facility leadership regarding grievance processes and appropriate responses.
• Provide guidance on documentation standards and complaint management practices.
• Support training and education efforts related to grievance handling and patient rights.
• Documentation and Recordkeeping Maintain accurate records of grievance and appeals investigations and outcomes.
• Ensure documentation is complete, defensible, and maintained in accordance with company policy and regulatory requirements.
• Perform other duties as assigned.

Benefits

• Competitive Pay and MVP Bonus Program
• Benefits package including Medical, Dental, and Vision insurance for you and your family
• Preferred Pharmacy Network options
• MDLIVE virtual Provider telehealth options
• Wellness program
• Health Savings Accounts and Health Reimbursement Account options with company match
• Employer-paid Life Insurance Policy/AD&D, Long-Term Disability and Short-Term Disability coverage
• Optional Voluntary coverage for Life Insurance, Accident, Critical Illness, and Hospital Indemnity plans
• Paid portion of Maternity Leaves
• Employee Assistance Program
• Generous Paid Time Off (PTO) including 10 Holidays and flexible Floating Holidays
• Participation in the MEDIKO 401(k) Retirement Plan with company match
• Employee Referral Bonuses
• Tuition Reimbursement Assistance Plan
• Free Continuing Education
• Access to Perks and Discounts at nationally recognized chains, service providers and retailers

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED