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Registered Nurse - Review & Evaluation (Blended Rate) (8411)

Review and Evaluation | Pittsburgh, PA | Contract

Job Description
Registered Nurse – Review & Evaluation (Blended Rate)
Work Location: Pittsburgh, PA

InGenesis is currently seeking a Registered Nurse – Review & Evaluation to work full time with our client in Pittsburgh, PA. In this role, you will evaluate and review medical, physical, rehabilitative, restorative and other care being provided to determine appropriateness.

This role requires significant travel to nursing facilities (NF), mostly one day with occasional overnight stays. If you meet the qualifications outlined below, apply now and we’ll reach out to answer any questions you may have!

Job Duties/Responsibilities
• Travel frequently to various NF to perform onsite reviews.
• Ensure compliance with department, state, and federal regulations and licensure requirements.
• Develop or revise medical assistance policies and regulations.
• Ensure appropriate services for individuals using long term living services.
• Monitor/review all long-term living settings.
• Determine the provision and adequacy of medical, social, physical, rehabilitative and restorative care services.
• Review Minimum Data Set (MDS) for accuracy and documentation support in clinical records.
• Review pre-admission screening process to ensure NF compliance with the Omnibus Budget Reconciliation Act (OBRA).
• Perform evaluations of targeted individuals in various care environments.
• Monitor appropriateness of NF admissions and determine need for continued stay.
• Perform financial reviews to identify recoveries.
• Assist Financial Representative with processing recoveries.
• Perform follow up reviews to ensure compliance with corrective action plans.
• Perform specialized reviews and projects with providers as necessary.
• Act as a resource for exchange of information through verbal and written communication.
• Provide technical assistance to NF staff as needed.
• Notify appropriate agencies of any issues identified during reviews.
• Participate in formal training programs.
• Perform other duties as assigned.

Minimum Qualifications
• Current Registered Nurse / RN license as issued by the state of Pennsylvania.
• Ability to travel frequently, mostly one day with occasional overnight stay.
• Reliable transportation and valid driver’s license, required.
• Previous experience with long term care, Minimum Data Sets ( MDS ), utilization, review, or OBRA, preferred.
• Excellent communication skills (written/verbal).
• Computer proficiency, including Microsoft Office.