Pennsylvania Licensed Review Nurse

Job Summary

A company is looking for a Review & Evaluation RN.

Key Responsibilities

• Perform review and evaluation of medical information and medical records for medical necessity and appropriateness of care
• Ensure eligible medical assistance recipients receive appropriate and quality medical care while detecting and correcting fraud and abuse
• Review and evaluate documentation to ensure proper billing of the Medical Assistance program

Required Qualifications

• Active RN license for the State of PA
• 3+ years of professional experience with medical assistance, health care services, or human services
• 3 years of recent experience in long term care, acute care, behavioral health, drug and alcohol settings, managed care, or quality management/utilization review