Job Title: Review & Evaluation RN (MUST BE ABLE TO COMMUTE TO HARRISBURG, PA AS NEEDED)

Location: Remote with 1 day a month onsite in Harrisburg, PA

Shift: Mon-Fri 7:30am-4pm

Pay: $31.00/hr.

Scheduled Pay: Weekly

Benefits: Health, Dental, Vision, Life Insurance, and short-term disability after 90 days

For more information, please contact Breanna D. directly at bdrollinger@alinestaffing.com

Review & Evaluation RN Description/Duties

· Perform review and evaluation of medical information and examination of medical records to assure the medical necessity, appropriateness, quality, quantity, adequacy and compensability of medical care and services under the Medical Assistance Program

· Responsible for the review and evaluation of medical information and examination of medical records and other documentation to assure that eligible medical assistance recipients receive appropriate and quality medical care, that the MA program is properly billed, and that provider and/or recipient fraud and abuse of the MA program is detected and corrected.

Review & Evaluation RN Requirements

· Active RN license for the State of PA

· Possess a documented work history of 3+ years of professional experience with medical assistance, health care services or human services

· 3 years of recent (within the last five years) professional experience in one or more of the following areas as related to the position need: long term care, acute care setting, behavioral health setting, drug and alcohol setting, managed care, quality management/utilization review.

JOB ID# 152677

Keywords: Registered Nurse, RN, review and evaluation nurse, Review Nurse, grievance, claims. management, audit, insurance, managed care, patient, patient healthcare, healthcare, dispute appeals, universal claims, complicated claims, outpatient, inpatient, telephonic utilization review, prior authorizations, case management, disease management, concurrent review, hospital, providers, member services, managed care, quality management, risk management, quality improvement, acute care, chronic care, critical care