Job Summary
A company is looking for a Review & Evaluation RN.
Key Responsibilities
- Perform review and evaluation of medical information and medical records for medical necessity and appropriateness of care
- Ensure eligible medical assistance recipients receive appropriate and quality medical care while detecting and correcting fraud and abuse
- Review and evaluate documentation to ensure proper billing of the Medical Assistance program
Required Qualifications
- Active RN license for the State of PA
- 3+ years of professional experience with medical assistance, health care services, or human services
- 3 years of recent experience in long term care, acute care, behavioral health, drug and alcohol settings, managed care, or quality management/utilization review
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