Travel Nurse RN - Utilization Review - $40 to $45 per hour in Harrisburg, PA

Job Type: Contract (12+ Months)

Description of Work/Duties Consultant will:

• Be available as a full-time consultant, approximately 37.5 hours per week.
• Possess an active Pennsylvania Registered Nurse license.
• Possess a documented work history of five (5) or more years of experience with claims review/coding or processing; be familiar with HCPCS II, CPT, or Dental coding.
• Possess computer skills, including familiarity with Microsoft Office programs, including Microsoft Excel/Word/PowerPoint.
• Possess prior experience with PROMISe or similar claims processing system.
• Possess prior experience with Medicare or Medical Assistance coding rules.
• Possess prior experience with researching medical policies, out of state comparison, participation in studies or projects.

Principal Duties and Responsibilities:

• Provide oversight to projects and processes for support of managerial leadership. Consultant will be assigned to workgroups and project teams. Assignments will consist of a combination of ongoing process responsibilities, standing workgroup participation, and time-limited projects related to the management and operations of all aspects of the Pennsylvania Medicaid program, including but not limited to:
  • Evaluation and implementation of system enhancements for provider enrollment, provider inquiry, and medical review.
  • Evaluation of current processes and implementation of recommended process improvement.
  • Consult with senior staff to outline major operational issues and develop resolutions based on sound data analysis.
  • Act as a liaison between the Client and external stakeholders (individuals and/or groups).
  • Assist in determining if any changes should be made to criteria or regulations to better serve clients.
  • Review certain claims, analyze, and process through the payment system.
  • Provide operational input for claims processing decisions.
  • Assist with coding and procedure code groupings.
  • Participate in the yearly coding updates and assist in updating the system according to the reviewed and accepted codes for the PA Medical Assistance Program.
  • Perform other related duties as assigned by the managerial staff.
  • Consultant will report to the state supervisor staff. Assignments will be received verbally or in writing, and will be carried out independently with minimal direct supervision.
  • Consultant, when requested, will work at one or more of the Department's work sites. Consultant's primary work location will be in Harrisburg, PA. Consultant will be provided with a desk, computer, phone, and all items necessary for them to complete assignments.

About our Company: -

22nd Century Technologies Inc., (TSCTI) is one the fastest growing healthcare staffing companies in the United States. With presence in all 50 States and 6000+ employees nationwide, we have been providing unparallel healthcare and technology staffing services to Public and Private sectors for over 26 years.

Started as a technology staffing company in 1997, we have significantly expanded our healthcare practice to both Clinical and Non-Clinical staffing, serving various facilities, healthcare organizations and government agencies. Our ISO certified staffing practices and technology driven staffing procedures – from recruitment to onboarding, along with an internal pre-vetted resume database of healthcare professionals, enable us to serve our customers with their immediate staffing needs.

TSCTI has extensive experience providing Physicians, Nurses, Pharmacists and other Allied Health professionals to various states – California, Connecticut, District of Columbia, Florida, Michigan, Minnesota, New Jersey, New York, Texas, Vermont, Virginia to name a few, and Our valued relationships with employees as well as commitment to meet and exceed clients’ expectations through our exemplary employees proves our competency in today’s healthcare staffing industry.

Recognized among “Best Company to Work For” by Forbes, 22nd Century Technologies, Inc., consistently exceeds our clients’ expectations by focusing on their absolute satisfaction with jobs while keeping our employees motivated.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.