Registered Nurse / RN - Review & Evaluation (12958)
Review and Evaluation | Harrisburg, PA | Contract
Registered Nurse / RN – Review & Evaluation
Work Location: Harrisburg, PA
InGenesis is currently seeking a Registered Nurse / RN to work with our client located in Harrisburg, PA. In this role, you will review and evaluate medical information/records to assure the medical necessity, appropriateness, and quality of care and services under the Medical Assistance Program.
If you meet the qualifications outlined below, apply today and we’ll reach out to answer any questions you may have!
• Detect and correct provider or recipient fraud and abuse.
• Analyze and evaluate provider documentation.
• Provide problem solving solutions to improve services or administrative procedures.
• Approve and deny request.
• Refer requests to physician, as needed.
• Enter data and decision into computerized system.
• Evaluate appeal request and medical records.
• Prepare cases, exhibits, and appeal correspondence.
• Testify at appeal hearings.
• Interpret MA policies, regulations, and procedures.
• Attend staff meetings.
• File and retain records.
• Perform other duties as necessary or assigned.
• Current Registered Nurse / RN license issued by the state of Pennsylvania.
• 3+ years of documented work history with medical assistance, health care services, human services, OR any equivalent combination of experience and training.
• Basic computer skills, including familiarity with Microsoft Office programs.
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.
InGenesis is proud to be an affirmative action employer and is committed to providing equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status. If you have a disability or special need that requires accommodation, please let us know by visiting our website at https://www.ingenesis.com/careers/site-accommodations.