Job Description

Job Description

Job Description

A-Line Staffing is now hiring a Medical Assistance Program Nurse Reviewer Remote In Pennsylvania (Must live is Pennsylvania) Please contact Marcia Hamilton at (586) 710-7979 or mhamilton@alinestaffing.com

Shift: Monday – Friday 8am to 5pm Remote needs to travel to Harrisburg, PA to pick up Equipment

Payrate: 27.00 an hour

We are seeking a dedicated and professional Registered Nurse to join our team in the review and evaluation of medical care provided under the Medical Assistance Program. The Nurse Reviewer is responsible for ensuring the quality, appropriateness, and compliance of medical services provided to eligible recipients, as well as identifying and addressing potential fraud or abuse. The position involves reviewing medical records, coordinating with service providers, and providing expert consultative services.

Medical Assistance Program Nurse Reviewer Minimum Qualifications:

• Possession of a current license to practice as a Registered Nurse issued by the Pennsylvania State Board of Nursing OR possession of a non-renewable temporary practice permit issued by the Pennsylvania State Board of Nursing (temporary permit holders must obtain licensure within one year as per Pennsylvania State Board of Nursing guidelines).
• Minimum two (2) years clinical expertise of physical disabilities, medical conditions, and treatment modalities.
• Minimum one (1) year quality improvement experience in multifaceted formal quality management program

Medical Assistance Program Nurse Reviewer Role Description: As a Nurse Reviewer, you will be responsible for evaluating the medical necessity, appropriateness, quality, quantity, adequacy, and compensability of services provided under the Medical Assistance Program. This includes reviewing medical records and other documentation to ensure eligible recipients receive appropriate care and that providers comply with billing and regulations. You may also serve as a team leader during complex reviews, provide advisory services, and represent the Department during appeals processes.

If you think this Medical Assistance Program Nurse Reviewer position is a good fit for you, please reach out to me - feel free to call, e-mail, or apply to this posting! Please contact Marcia Hamilton at (586) 710-7979 or mhamilton@alinestaffing.com

 

Job Tags

Temporary work, Immediate start, Remote job, Shift work, Monday to Friday,

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