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