Registered Nurse - Audit and QI | Norristown, PA | Full Time
(Review and Evaluation, Utilization Review)
A successful and established Workforce Solutions Company is accepting applications for qualified RN's to provide services to the Office of Long Term Living. The position offers a structured schedule which allows for a great work/life balance all while servicing your local government and making a difference in your community.
Counties of responsibility: Chester, Delaware, Philadelphia
Duties include but are not limited to:
- 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, abuse and waste of the Medical Assistance Program is detected and corrected.
- Analyze and evaluate documentation submitted by the Medical Assistance Program service providers and generated through PROMISe™ in order to make professional medical judgments regarding the appropriateness of services provided to eligible recipients under the Medical Assistance Program.
- Conduct reviews with the Medical Assistance Program service organizing and coordinating the review process.
- Provide advisory and consultative services to boards and staff designed to improve the services or administrative procedures.
- Represent the Department in an official capacity during an appeal process.
- Must show a large degree of judgment and discretion.
- Coordinate on-site NF reviews, including pre-review activities, entrance and exit conferences appropriate paperwork during the review and all post review activities.
- Perform follow up reviews to insure compliance with corrective action plans as submitted by the nursing facility.
- Perform any specialized reviews and projects with MA/OLTL providers as necessary.
- Currently licensed to practice as a Registered Nurse and possess an active unrestricted license issued by the Pennsylvania State Board of Nursing.
- Minimum of three years (within the last five years) in long-term care.
- Proficient writing and basic computer skills to include, but not limited to, Microsoft Office Products.
We support a diverse workforce and is an Equal Opportunity Employer who does not discriminate against employees and applicants for employment on the basis of race, gender, color, religion, national origin, age, sexual orientation, gender identity, genetic information, disability, veteran status, or other classification protected by law.