Pennsylvania Licensed Review RN

Job Summary

A company is looking for a Review & Evaluation RN.

Key Responsibilities

• Review and evaluate medical information and records to ensure medical necessity and appropriateness of care
• Ensure eligible medical assistance recipients receive quality medical care and that the program is properly billed
• Detect and correct provider and/or recipient fraud and abuse within the Medical Assistance Program

Required Qualifications

• Active RN license for the State of PA
• 3+ years of professional experience in medical assistance, health care services, or human services
• 3 years of recent experience in areas such as long-term care, acute care, or managed care
• Experience in quality management or utilization review is preferred