Medical Review Nurse

Job Description Job Description Job Title: Medical Review Nurse Location: Harrisburg, PA Shift: Mon-Fri 7:30am-4pm Pay: $31.00 per hour Scheduled Pay: Weekly Benefits: Health, Dental, Vision, Life Insurance, and short-term disability after 90 days Ready to apply or have questions? Contact- Ashley Kruger Call/Text- 586-710-7947 Medical Review Nurse Description/Duties Perform review and evaluation of medical information and examination of medical records to assure the medical necessity, appropriateness, quality, quantity, adequacy and compensability of medical care and services under the Medical Assistance Program Responsible 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, that the MA program is properly billed, and that provider and/or recipient fraud and abuse of the MA program is detected and corrected. Medical Review Nurse Requirements Active RN license for the State of PA 3 years of professional experience with medical assistance, health care services or human services 3 years of recent (within the last five years) professional experience in one or more of the following areas as related to the position need: long term care, acute care setting, behavioral health setting, drug and alcohol setting, managed care, quality management/utilization review. Ready to apply or have questions? Contact- Ashley Kruger Call/Text- 586-710-7947 Keywords: Registered Nurse, RN, review and evaluation nurse, Review Nurse, grievance, claims. management, audit, insurance, managed care, patient, patient healthcare, healthcare, dispute appeals, universal claims, complicated claims, outpatient, inpatient, telephonic utilization review, prior authorizations, case management, disease management, concurrent review, hospital, providers, member services, managed care, quality management, risk management, quality improvement, acute care, chronic care, critical care Clinical Review Nurse, Utilization Review Nurse, Clinical Quality RN, Care Review Specialist – RN, RN Case Reviewer, Clinical Evaluation Nurse, Nurse Auditor, Medical Review Nurse, RN Quality Assurance Specialist, Health Services Review Nurse

Location: Harrisburg, Pennsylvania, US

Posted Date: 7/11/2025