Hybrid Review & Evaluation RN {169547}

Job Title : Hybrid Review & Evaluation RN
Location: Harrisburg Pennsylvania 17101 (2 days onsite, 3 days WFH)

• Training may be onsite!
• Some travel may be required , and additional details can be discussed further during interviews

Work Schedule: Monday-Friday, 8:00am-4:00pm

Pay: $30.00- $32.00 per hour
Scheduled pay: Weekly
Benefits: Health, Dental, Vision, Life Insurance, and Short term disability after 90 days, 12 paid holidays and 5 days of PTO
Job Type: Full Time

Ready to apply or have questions?

Contact- Ashley Kruger
Call/Text-

Email-

Review & Evaluation RN Responsibilities

• Review and evaluate medical necessity, appropriateness, quality, quantity, adequacy, and compensability of care and services
• Examine medical records and supporting documentation for compliance and quality standards
• Analyze provider-submitted documentation to make professional clinical determinations
• Identify potential fraud, abuse, or billing concerns and support corrective action
• Conduct desk, telephonic, and on-site reviews as needed
• Prepare correspondence, reports, and findings related to case reviews
• Provide consultative support to internal teams and stakeholders
• Serve as a team lead during multi-staff reviews when needed
• Represent the department during appeals and related proceedings

Review & Evaluation RN Required Skills & Qualifications

• Current RN license issued by the Pennsylvania State Board of Nursing
• 3 years of professional experience as a Registered Nurse
• 3 years of recent experience within the last 5 years in one or more of the following: Long-term care, Acute care, Behavioral health, Drug and alcohol, Managed care, Quality management/utilization review, Related clinical experience

Ready to apply or have questions?

Contact- Ashley Kruger
Call/Text-

Email-

Registered Nurse RN, Nurse Reviewer, Acute Care, Long Term Care, LTC, Managed Care, Utilization Review Nurse, Medical Review Nurse, Clinical Reviewer, Nurse Auditor, Medical Necessity, Documentation Review, Medical Record Review, Prior Authorization, Post Certification Review, Quality Management, Medicaid, Medical Assistance, OLTL, Long Term Care, Managed Care, Behavioral Health, F, InterQual, ICD-9, CPT, , Microsoft Office