R&E Nurse- Med Care Services - Intermediate

Job Title: R&E Nurse- Med Care Services - Intermediate Address: Harrisburg, PA Job Description Review and evaluate medical necessity, appropriateness, quality, quantity, adequacy, and compensability of care and services provided under the Medical Assistance Program. Examine medical records and documentation to ensure eligible recipients receive appropriate, quality care. Detect and correct provider or recipient fraud and abuse. Conduct reviews in central office, on-site at facilities, or via telephone for services requiring prior authorization or post-certification. Provide advisory and consultative services to improve services and administrative procedures. Prepare correspondence and reports, and conduct field work or desk and telephonic reviews. Review and evaluate provider documentation for compliance with Medical Assistance regulations. Critical Information Shift time: 8-4 On-site at OLTL - FOO - Headquarters, 555 Walnut Street, Forum Place, 6th Floor, Harrisburg, PA. Education/Licenses Needed Current RN license issued by the Pennsylvania State Board of Nursing, or non-renewable temporary practice permit. Minimum of 3 years of professional experience in medical assistance (MA), health care, or human services. Benefits: Benefits are available to full-time employees after 90 days of employment. A 401(k) with company match is available after 1 year of service. This is an AI-formatted job description; recruiter confirmation required.