Remote Review and Elevations Nurse – WILL TRAIN Position Available In Dauphin, Pennsylvania

Remote Review and Elevations Nurse – WILL

TRAIN 3.9 3.9

out of 5 stars Harrisburg, PA 17101 • Remote A-Line Staffing is now a motivated and detail- oriented REMOTE Review and Elevation Registered Nurse In Harrisburg, PA Please contact Marcia Hamilton at (586) 710-7979 or mhamilton@alinestaffing.com

WILL TRAIN!

!!!!!!

WILL TRAIN!

!!!! Registered Nurse –

Medical Assistance Program Reviewer Location:

Must Live In Pennsylvania, Must travel to Harrisburg, PA once a month and to pick up equipment. 8 week training in person and after the training position will be fully remote and once a month in office

LONG TERM CONTRACT

Position Shift:

7:30 AM – 4:00 PM (1 hour lunch)

Payrate:

$31.00 an hour

Job Overview:

We are seeking a dedicated Registered Nurse to join our Medical Assistance Program team. This position requires residency within the state and involves work primarily in a call center environment, with some onsite training. The role focuses on reviewing and evaluating medical necessity, appropriateness, and quality of care provided under the Medical Assistance Program.

Key Responsibilities:

Review and evaluate medical records and documentation to ensure eligible recipients receive appropriate, quality medical care. Analyze service provider submissions and data generated through PROMISe’ for accuracy and compliance. Identify and address provider/recipient fraud or abuse within the Medical Assistance Program. Conduct reviews onsite, telephonically, or at central office as required. Serve as team leader for complex reviews involving multiple staff. Provide advisory and consultative services to improve patient care and administrative procedures. Represent the Department during appeal processes as needed. Prepare detailed correspondence and reports related to case reviews. Attend trainings, meetings, and conduct fieldwork statewide, including overnight stays.

Minimum Qualifications:

Current Registered Nurse license issued by the Pennsylvania State Board of Nursing, OR Non-renewable temporary practice permit from the Pennsylvania State Board of Nursing (must obtain RN licensure within one year). Proficiency in writing and basic computer skills, including Microsoft Office. Minimum of three years of professional experience in medical assistance healthcare services or human services. At least three years of recent (within five years) experience in one or more of the following areas: long-term care, acute care, behavioral health, drug and alcohol treatment, managed care, quality management/utilization review, or equivalent clinical experience. Knowledge of InterQual criteria, ICD-9 CM, and current procedure terminology preferred. Ability to apply professional judgment in review processes and identify irregularities. A-Line Staffing is now a motivated and detail- oriented REMOTE Review and Elevation Registered Nurse In Harrisburg, PA – Please contact Marcia Hamilton at (586) 710-7979 or mhamilton@alinestaffing.com ESJKS2

Job Type:

Full-time Pay:

$31.00 per hour

Benefits:

401(k) 401(k) matching Dental insurance Health insurance Life insurance Vision insurance

Schedule:

8 hour shift Day shift Monday to Friday No weekends

Work Location:

Hybrid remote in Harrisburg, PA 17101