Registered Nurse - Grievance and Appeals
- Mediko
- Harrisburg, Pennsylvania
- 1 day ago
- Full Time
Job Summary
Employment Type
Full Time
Job Description
Job DetailsJob Location: Dauphin County Prison - Harrisburg, PA 17111Position Type: MEDIKO Employee - Full TimeJob Shift: Day ShiftMEDIKO: 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.
How YOU can Make an Impact:
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.
What we Ask of YOU:
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.
An Associate’s or Bachelor's degree in Healthcare, Nursing, or a related field is preferred but not 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).
Joining MEDIKO comes with perks to support you in your personal and professional journey:
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
EOE STATEMENT: We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law.
Qualifications
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.
How YOU can Make an Impact:
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.
What we Ask of YOU:
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.
An Associate’s or Bachelor's degree in Healthcare, Nursing, or a related field is preferred but not 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).
Joining MEDIKO comes with perks to support you in your personal and professional journey:
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
EOE STATEMENT: We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law.
Qualifications
Job Summary
Employment Type
Full Time
Benefit Insights
Health Insurance
Paid Time Off
Vacation Leave
Sick Leave
401(k)
Holiday Pay
Health & Wellness Programs
Tuition Reimbursement
Health Savings Accounts (HSAs)
Medical Flexible Spending Account
Paid Parental Leave
Life Insurance
Dental Insurance
Vision Insurance
Short-Term Disability
Long-Term Disability
Mediko
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Job ID: 513808376
Originally Posted on: 3/16/2026
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