Registered Nurse- Medical Review & Quality
Job Description
A-Line Staffing is now hiring Registered Nurse- Medical Review & Quality in Harrisburg, PA f you are interested in this Registered Nurse- Medical Review & Quality position, please contact Alexis at 1586-422-1748 or [email protected] Job Title: Registered Nurse- Medical Review & Quality Location: Harrisburg, PA Hybrid after 8 Weeks Schedule: Monday-Friday | 8:00 AM - 4:00 PM Job Type: Long-Term Contract Pay rate: 28.00-31.00per hour Registered Nurse- Medical Review & Quality Highlights
- Day shift schedule-no nights or rotating shifts
- Expand your career into utilization review, quality assurance, and medical policy
- Work in a professional, collaborative office environment
- Opportunity to influence healthcare quality at a system level
- Mix of office, remote review, and occasional field work
- Long-term, stable contract with growth potential
Registered Nurse- Medical Review & Quality Responsibility
- Review medical records to evaluate medical necessity, quality, and appropriateness of care
- Analyze provider documentation to ensure compliance with Medical Assistance (Medicaid) regulations
- Identify potential fraud, waste, or abuse and recommend corrective action
- Apply clinical guidelines such as InterQual and medical coding standards (ICD, CPT)
- Conduct reviews on-site, remotely, or via phone for prior authorization and post-certification
- Serve as a team lead on multi-review projects when needed
- Prepare detailed reports and documentation to support findings
- Provide consultation to internal teams and external providers
- Represent the department in appeals and administrative hearings
Registered Nurse- Medical Review & Quality Requirements
- Active Registered Nurse (RN) license in Pennsylvania
- 3+ years of professional healthcare experience
- 3+ years of recent experience in one or more of the following: Long-term care ,Acute care, Behavioral health ,Drug & alcohol services ,Managed care , Utilization review or quality management
- Strong clinical judgment and attention to detail
- Experience reviewing medical records and documentation
- Basic proficiency in Microsoft Office
- Experience with InterQual criteria
- Familiarity with ICD-9/ICD-10 and CPT coding
If you think this Registered Nurse- Medical Review & Quality position is a good fit for you, please reach out to me - feel free to call, e-mail, or apply to this posting! For more information, please contact Alexis Staffing Manager Apply tot his job Apply To this Job