41 R&E Nurse, Med Care Services-Harrisburg,PA Jobs in Harrisburg, PA
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R&E Nurse, Med Care Services-Harrisburg,PA
$84k-105k (estimate)
Full Time
2 Months Ago
Morgans Healthcare is Hiring a R&E Nurse, Med Care Services-Harrisburg,PA Near Harrisburg, PA
Job DescriptionWE ARE HIRING!!!Morgans Healthcare is a New York-based staffing agency that specializes in placing healthcare professionals into temporary travel and local contracts across the United States.
We are in search for a Review and Evaluation Nurse in Harrisburg, PA Rate:
Minimum Qualifications
Morgans Healthcare is a New York-based staffing agency that specializes in placing healthcare professionals into temporary travel and local contracts across the United States.
We are in search for a Review and Evaluation Nurse in Harrisburg, PA Rate:
- $32 per hour
- 8a – 4pm (30 min lunch
- Full time, Monday- Friday
- would be required to come into the office once a week and every day until training is complete
Minimum Qualifications
- RN License issued by the Pennsylvania State Board of Nursing
- Proficient writing and basic Computer Skills to include, but not limited to, Microsoft Office Products
- Three years of professional experience with medical assistance (MA), health care services, or human services
- Minimum of three 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 or other related clinical experience; or
- An equivalent combination of experience and training in the field of medical assistance (MA), health care services, human services, long term care, utilization review, or knowledge of home care
- Knowledge of and familiarity with the following would be beneficial: Inter- Qual criteria, ICD-9 CM, and current procedure terminology,
- Ability to use professional judgment in identifying aberrant patterns and determining the appropriate action to be taken following the documentation review.
- This is work in the review and evaluation of the medical necessity, appropriateness, quality, quantity, adequacy, and compensability of medical care and services rendered by service providers under the Medical Assistance Program. A resource is 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 Medical Assistance Program is properly billed, and that provider and/or recipient fraud and abuse of the Medical Assistance Program is detected and corrected.
- Work involves the analysis and evaluation of documentation submitted by Medical Assistance Program service providers and generated through PROMISe' in order to make professional medical judgments regarding the appropriateness of the care and services provided to eligible recipients under the Medical Assistance Program. Reviews may be conducted in central office with the Medical Assistance Program service provider furnishing the necessary medical records, on site at the facility, or information may be provided over the telephone for any service that may require prior authorization or post certification.
- Work may include serving as a team leader on reviews requiring more than one staff member organizing and coordinating the review process. Resources also provide advisory and consultative services to boards and staff designed to improve the services or administrative procedures in support of medical assistance patients.
- Work may also involve the resource representing the Department in an official capacity during an appeal process. Judgment and discretion are required in conferring with advisory boards, facility officials, providers, and staffs. Work is performed under the supervision of an administrative superior and is reviewed through conferences and reports.
Morgans Healthcare is a New York-based staffing agency that specializes in placing healthcare professionals into temporary travel and local contracts across the United States.
Job Summary
JOB TYPE
Full Time
SALARY
$84k-105k (estimate)
POST DATE
07/22/2024
EXPIRATION DATE
09/21/2024
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