Review and Evaluation Nurse
Review and Evaluate the medical necessity, appropriateness, quality, quantity, adequacy and compensability of medical care and services rendered by Hospice providers under the Medical Assistance Program. The nurse is responsibile for the review and evaluation of medical information and examination of medical records and other documentation to assure that eligible medical assistance recipients receive appropriate and quality medical care. The Medical Assistance Program must be properly billed, and that the provider and/or recipient fraud, abuse and waste is detected.
Requirements
Able to prepare correspondence and reports.
Comprehend and apply regulations, policies and standards.Establish and maintain effective working relationships.
Carry out instructions and complete assignments.
Ability to conduct field work, desk and telephone reviews.
Travel to facilities/providers sites to conduct reviews and attend training and meetings as required across the state (Includes overnight stays)
Communicate effectively (verbally and in writing) with coworkers, management, Office of General Council, other agencies, facility staff and other medical assistance providers to review and discuss cases.
Enter essential data into the computer.
Physically traverse stairs, lift laptop, printer and related equipment, walk long distances and sit for long periods of time.
Review and evaluate provider documentation to determine compliance with Medical Assistance regulations.
Testify at administrative/legal hearings and to defend Department decisions.
Maintain discretion and confidentiality.
Recommended Jobs
Au Pair
Get hired for Sarah's aupair Job in Williamsport, PA. Family of 5 Seeks Help with 3 Kids. Find aupair care work in Williamsport.
Direct Support Professional Residential
Job Description Job Description Job description Direct Care Worker LNL Home Services will fully train and support you 365 days. Let’s make a difference in someone’s life together! Multipl…
Accounts Payable Processor
Love numbers? Organized to a T? Ready to join a team that values your skills? Honor Foods is looking for a detail-oriented Accounts Payable Processor to keep our finance operations running smooth…
Part-Time Parts-Delivery Driver
DESCRIPTION: Hill International Trucks, the tri-state areas leading medium- and heavy-duty truck and trailer dealership, is currently seeking part-time non-CDL delivery drivers to support its parts d…
Project Engineer Sr Stf - Proposal Lead
Description: The coolest jobs on this planet or any other are with Lockheed Martin Space. For over 60 years, the Fleet Ballistic Missile (FBM) team has supported the Navys mission to provide an…
Physician Pediatrics General-1
Job SummaryGeisinger is seeking a General Pediatrician to join our team in Wilkes-Barre, PA. Wilkes-Barre sits along the scenic Susquehanna River and is an outdoor enthusiast's paradise for kayaking,…
Phlebotomist / Laboratory Assistant - Penn Presbyterian Medical Center
**Description** Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of me…
Head Coach
Job Description Job Description The Exercise Coach is a boutique personal training studio that delivers one on one and small group training sessions. The Exercise Coach leverages hi-tech equipmen…
Educator of Future Minds: Early Childhood Educator
Job Description Job Description Generous SIGNING BONUS for all new hires! We need passionate teachers for our young students! Our Goddard School located at 1050 Andrew Drive, West Chester, PA 1…
General Manager - New Construction Plumbing and HVAC
Job Description Job Description Job Title: General Manager Department: Construction Operations – Plumbing & HVAC Division Reports To: Vice President of Operations / Ownership Locatio…