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Location

Harrisburg, PA | United States

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Job description

Position Hours:

Monday to Friday: 8:00 am - 4:30 pm (30-minute lunch)
Training Details:

Onsite training required for 2-8 weeks
Hybrid schedule: 1-2 days in-office, 3-4 days remote
8 hours per day required
Compensation:

Competitive hourly rate: $31.00 per hour
Benefits available to full-time employees after 90 days of employment
401(k) with a company match for full-time employees with 1 year of service
Responsibilities:
As a Hybrid Research RN, you will play a vital role in reviewing and evaluating the medical necessity, appropriateness, quality, quantity, adequacy, and compensability of medical care and services provided under the Medical Assistance Program. Key responsibilities include:

Reviewing and evaluating medical information and examining records to ensure eligible recipients receive appropriate and quality medical care.
Ensuring accurate billing within the Medical Assistance Program and detecting/correcting instances of provider and/or recipient fraud and abuse.
Analyzing documentation submitted by service providers to make professional medical judgments on the appropriateness of care and services provided to eligible recipients.
Requirements:
To be successful in this role, you should possess:

Current license to practice as a Registered Nurse issued by the Pennsylvania Board.
Experience in long-term care, acute care, behavioral health, drug and alcohol, managed care, quality management/utilization review, or home care.
Proficient writing and basic computer skills, including Microsoft Office Products.
Knowledge of and familiarity with Inter-Qual criteria, ICD-9 CM, and current procedural terminology would be beneficial.
How to Apply:
If you believe this Hybrid Research RN position aligns with your skills and career goals, please don't hesitate to reach out. You can call, email, or apply directly to this posting. We look forward to hearing from you and exploring the possibility of working together to make a positive impact on healthcare.
Employment Type: Full-Time
Salary: $ 31.00 Per Hour

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Job tags

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Salary