REGISTERED NURSE JOB SUMMARY:

• Participate in the operation of the retrospective fraud and abuse program which includes medical record reviews and validation surveys to verify and assess the medical care rendered by providers enrolled in the MA Program.
• Identify discrepancies through the analysis of paid claims and reports through the Fraud Abuse Detection System. This includes, but is not limited to, analysis of paid claims for patterns identified with high-cost, high-volume providers, and potential cases for review.
• Selects, reviews, analyzes, and evaluates cases retrospectively to monitor compliance with state and federal regulations.
• Services are monitored for medical necessity and quality of care. Verify that services ordered were rendered, and all rendered services were ordered and are appropriate.

REGISTERED NURSE HIGHLIGHTS:

• Work schedule: Mon-Fri, 8a-4p
• Must be a resident of Pennsylvania to be considered
• REMOTE opportunity but will require training onsite for 8 weeks in Harrisburg, PA plus one day per week in-office after training is complete
• This role is perfect for any RN seeking to leave bedside nursing/acute/clinical nursing and looking to gain new experience away from the bedside!
• Full benefits available after 90 days: Medical, Dental, Vision, Life, Short-term Disability
• 401k after 1 year of employment: With employer match and profit sharing
• The compensation for this position is $31 per hour, paid weekly

REGISTERED NURSE QUALIFICATIONS:

• Active RN License in the State of PA with NO past or present actions/suspensions or probation
• Acute care/clinical (hospital) experience required
• Computer savvy- experience with MS Office programs required.
• High speed internet and private/quiet space to work remote is required.

PLEASE CALL OR TEXT: Alliston Brown @ 586-710-7944

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