Join our esteemed organization as a Hybrid Research RN, where you will be instrumental in delivering top-tier medical care and ensuring the integrity of healthcare services. This remote position is perfect for dedicated professionals who are eager to make a significant impact in the healthcare sector.
Key Responsibilities
• Evaluate and assess the medical necessity, quality, and appropriateness of care provided under the Medical Assistance Program.
• Ensure that recipients of medical assistance receive adequate care while adhering to program compliance standards.
• Review and analyze medical records and documentation to provide informed medical judgments.
• Identify and address instances of fraud and abuse within the provider or recipient framework.
Required Skills
• Valid Registered Nurse license in Pennsylvania.
• Experience in long-term care, acute care, behavioral health, substance use, managed care, quality management/utilization review, or home care settings.
• Strong writing abilities and proficiency in basic computer skills, including Microsoft Office applications.
• Familiarity with InterQual criteria, ICD-9 CM, and current procedural terminology is advantageous.
Qualifications
• Current license to practice as a Registered Nurse in Pennsylvania.
• Relevant experience in healthcare environments preferred.
Career Growth Opportunities
This role offers a unique chance to develop your professional skills while making a real difference in patient care. Be part of a collaborative team dedicated to advancing healthcare quality and ensuring compliance with medical assistance programs.
Company Culture And Values
Our organization prides itself on a culture of support and respect. We value the expertise and experience of our staff and encourage a workplace that fosters professional growth and collaboration.
Compensation And Benefits
• Hourly Pay: $31.00 per hour
• Benefits: Eligible for comprehensive benefits after 90 days of employment for full-time employees.
• 401(k): Available for full-time employees after one year of service, with a company match on eligibility dates.
