RN-Review and Evaluation
Health Care | Harrisburg, PA | Full Time
RN-Review and Evaluation of Medical Care and Services
Non Direct Patient Care
InGenesis is seeking qualified RN's to provide services to the Commonwealth of Pennsylvania. 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.
Duties include but are not limited to:
Candidate 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, abuse and waste of the Medical Assistance Program is detected and corrected.
- Candidate must 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 the Hospice care and services provided to eligible recipients under the Medical Assistance Program.
- Candidate will provide education to other staff, offices and Department attorneys regarding current standards of Hospice care.
- Candidate will conduct reviews in central office with the Medical Assistance Program service organizing and coordinating the review process.
- Candidate will also provide advisory and consultative services to boards and staff designed to improve the services or administrative procedures.
- Candidate may also represent the Department in an official capacity during an appeal process.
- Candidate must show a large degree of judgment and discretion.
- Must have an RN license. Will be working with the OBRA program.
- Experience working with individuals with intellectual and developmental disabilities.
- Professional references must demonstrate effective time management, leadership skills, task completion, ability to communicate effectively with health care professionals and non-health care staff
- Minimum of 5 years of experience in working with individuals with I/DD
- Position will be headquartered at central office (in Harrisburg, PA)
- Travel to the regions will be necessary intermittently (there will be travel)
- Experience with Microsoft Office (Word, Excel, PowerPoint)