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Registered Nurse - Review & Evaluation Med Care Service (1797)

Medical Auditor | Harrisburg, PA | Contract

Job Description
Registered Nurse – Review & Evaluation Med Care Service
Work Location: Harrisburg, PA

Job Summary/Description
In this role, the Registered Nurse 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 may include serving as a team leader on reviews requiring more than one staff member organizing and coordinating the review process. 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 as well as holding the responsibility to ensure the health and safety of participants receiving supports and services in a community-based setting. The RN will assist with the mortality review process in reviewing deaths, gathering supporting documentation, analyzing the data, completing the report for the mortality review team, and implement recommendations from the mortality review team. Judgment and discretion are required in conferring with advisory boards, facility officials, providers, and staffs. If you meet the qualifications, please apply and a Recruiter will reach out to you and answer any questions you may have.

Job Duties/Responsibilities/Functions (including but not limited to)
• Ability to prepare correspondence and reports.
• Ability to comprehend and apply regulations, policies and standards.
• Ability to establish and maintain effective working relationships.
• Ability to carry out instructions and complete assignments.
• Ability to conduct field work, desk and telephonic reviews.
• Ability to travel to facilities/provider sites to conduct reviews and attend training and meetings as needed, across the State (includes overnight stays).
• Ability to communicate effectively (verbally and in writing) with coworkers, management, Office of General Counsel other agencies, nursing facility staff and other medical assistance providers to review and discuss cases.
• Ability to enter essential data into the computer.
• Ability to physically traverse stairs, lift laptop, printer and related equipment, walk long distances and sit for long periods of time.
• Ability to review and evaluate provider documentation to determine compliance with Medical Assistance regulations.
• Ability to testify at administrative/legal hearings and to defend Departmental decisions.
• Ability to maintain discretion and confidentiality.
• Performs other duties as assigned and/or requested.

Minimum Qualifications
• Possession of a current license to practice as a Registered Nurse issued by the Pennsylvania State Board of Nursing; OR
• Possession of a non-renewable temporary practice permit issued by the Pennsylvania State Board of Nursing. Resources possessing non-renewable temporary practice permits must obtain licensure as a Registered Nurse within the one-year period as defined by the Pennsylvania State Board of Nursing.
• Proficient writing and basic Computer Skills to include, but not limited to, Microsoft Office Products.
• Three (3) years of professional experience with medical assistance (MA), health care services, or human services.
• Minimum of three (3) 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.
• Long term living care experience is highly preferred.
• Ability to use professional judgment in identifying aberrant patterns and determining the appropriate action to be taken following the documentation review.

About InGenesis
InGenesis is dedicated to placing people in positions that preserve life, improve lives and inspire others. This does not happen without passionate people, skilled colleagues who are motivated to create innovative solutions and deliver superior service to our clients. Founded in 1998, InGenesis manages thousands of employees, including pioneering healthcare, science, technology and pharma professionals. The workforce solutions company includes almost half of the Fortune 500 in its nearly 300 clients. It is recognized as one of the largest healthcare staffing firms, and InGenesis is the largest minority/women owned healthcare staffing firm in North America.

EEOC Statement
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.