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Pennsylvania Licensed Review RN
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
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
