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

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