RN Quality Review & Evaluation Care Medical Services (R&E) — 5x8s Days (Harrisburg, PA)

Overview

Join a professional office setting in Harrisburg, PA as an RN Review & Evaluation (R&E) Nurse supporting medical service quality and compliance under the Medical Assistance Program. In this role, you’ll review and evaluate medical records, analyze provider submissions and Promise™ data, and help identify issues related to medical necessity, quality of care, and regulatory requirements—while producing clear documentation and reports for internal and external stakeholders.

Job Details

  • Weekly Pay / Pay Rate: $20/hr
  • OT Rate: $50/hr
  • Weekly Stipend: $1,350
  • Weekly Gross: $2,150
  • Guaranteed Hours: 40
  • Shifts: 8A–4P
  • Work Schedule: 5x8s (Days)
  • Contract Length: Not provided
  • Start Date: 07/06
  • Work Location/Setting: In person — professional office setting
  • Location: Harrisburg, PA

Required Skills

  • Active RN license issued by the Pennsylvania State Board of Nursing OR non-renewable temporary practice permit (must obtain RN licensure within one year)
  • 3 years of professional experience in medical assistance (MA), healthcare services, or human services
  • 3+ years (within the last five years) in one or more of the following:
    • Long-term care, Acute care, Behavioral health, Drug and alcohol services, Managed care, Quality management/utilization review, or other related clinical settings
  • Proficiency in writing and basic computer skills (including Microsoft Office)
  • Knowledge of InterQual criteria, ICD-9 CM, and CPT terminology
  • Ability to exercise professional judgment to identify irregular patterns and determine appropriate actions
  • Strong analytical and critical thinking skills
  • Ability to interpret and apply healthcare regulations, policies, and standards
  • Effective verbal and written communication skills
  • Ability to establish and maintain professional working relationships
  • Ability to conduct on-site, desk, and telephonic reviews
  • Ability to prepare detailed reports, correspondence, and documentation of findings
  • Ability to represent the Department in administrative or legal hearings (as needed), including preparing to testify
  • Capability to conduct travel/fieldwork across the state (overnight stays may be required)
  • Physical ability to travel, walk distances, carry equipment, and sit for extended periods

Nice to Have Skills

  • InterQual / ICD-9 CM / CPT terminology knowledge (preferred)
  • Writing and documentation experience that supports hearing/testimony preparation (helpful for complex reviews)

Preferred Education and Experience

  • Education: Not specified
  • Experience: Professional RN experience aligned to medical assistance and clinical settings, including 3+ years within the last five years in relevant areas (long-term care, acute care, behavioral health, drug and alcohol services, managed care, quality management/utilization review, or other related settings)

Other Requirements

  • Registered Nurse (RN) license required (or temporary practice permit with licensure within one year)
  • Travel across the state required for fieldwork (overnight stays may be required)
  • Work is in person

Equal Opportunity Employer

We are an Equal Opportunity Employer. All qualified applicants will receive consideration without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other protected characteristic.

If you meet the RN and medical assistance review experience requirements, submit your application now for the RN Quality Review & Evaluation Care Medical Services (R&E) 5x8s Days role in Harrisburg, PA.