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Location

Harrisburg, PA | United States

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Job description

We are currently seeking a dedicated and skilled Registered Nurse for a Hybrid Research role. As a member of our team, you will play a crucial role in ensuring the medical necessity, appropriateness, quality, and compensability of medical care and services provided under the Medical Assistance Program. We are committed to maintaining a supportive work environment where your expertise and compassion make a difference.

Responsibilities:

Conduct comprehensive reviews and evaluations of medical necessity, appropriateness, quality, and quantity of medical care and services offered by service providers under the Medical Assistance Program.

Evaluate medical information, thoroughly examine medical records, and analyze documentation to ensure eligible medical assistance recipients receive appropriate and high-quality medical care.

Monitor and verify that the Medical Assistance Program is accurately billed, while actively detecting and correcting instances of provider and/or recipient fraud and abuse.

Analyze and assess documentation submitted by Medical Assistance Program service providers, utilizing Promise' to make professional medical judgments on the appropriateness of care and services for eligible recipients.

Requirements:

Possession of a current Registered Nurse license issued by the state of Pennsylvania.

Proven experience in long-term care, acute care, behavioral health, drug and alcohol, managed care, quality management/utilization review, or home care.

Proficient writing skills and basic computer proficiency, including Microsoft Office Products.

Knowledge of and familiarity with Inter-Qual criteria, ICD-9 CM, and current procedure terminology would be beneficial.

Compensation and Benefits:

Competitive hourly rate of $31.00.

Full-time employees are eligible for benefits after 90 days of employment.

401(k) with company match available for full-time employees with 1 year of service on eligibility dates.

Join us in making a positive impact on the healthcare community and contribute to the success of our mission. If you are a compassionate and dedicated RN seeking a challenging yet rewarding position, we invite you to apply and be a part of our dynamic team. Please note that this opportunity is with a confidential healthcare organization.
Employment Type: Full-Time
Salary: $ 31.00 Per Hour

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Job tags

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Salary