R E Nurse- Med Care Services
Location: Pittsburgh
Posted on: June 23, 2025
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Job Description:
A-Line Staffing is now hiring an R&E Nurse – Med Care
Services – Intermediate in Pittsburgh, PA. The R&E Nurse would
be working for a state agency and has strong potential for career
growth. This would be full time / 40 hours per week. R&E Nurse
Compensation Benefits are available to full-time employees after 90
days of employment A 401(k) with a company match is available for
full-time employees with 1 year of service on our eligibility dates
R&E Nurse Highlights This position is a contract assignment
with potential to become long-term depending on performance and
agency needs The required availability for this position is 1st
shift: Monday–Friday, 8:00 AM – 4:00 PM (on-site full time) R&E
Nurse Responsibilities Review and evaluate the medical necessity,
quality, appropriateness, and adequacy of services under the
Pennsylvania Medical Assistance Program Analyze medical records to
ensure proper billing and detect provider or recipient fraud and
abuse Conduct desk, field, and telephonic reviews across a variety
of healthcare settings including long-term care, behavioral health,
and acute care Prepare documentation for official appeals and
provide expert testimony when necessary Serve as team lead on
larger audits and reviews Communicate with providers, agencies, and
state departments to ensure compliance with policy and regulations
Travel required for field reviews and meetings; includes overnight
stays Use systems such as PROMISe and apply professional standards
such as InterQual, ICD codes, and CPT terminology R&E Nurse
Requirements Current PA Registered Nurse (RN) license or a
non-renewable temporary practice permit Minimum three years of
professional experience in medical assistance healthcare, human
services, or clinical settings such as long-term care, behavioral
health, managed care, or utilization review Strong written and
verbal communication skills Basic computer proficiency, including
Microsoft Office Ability to interpret regulations, conduct
documentation audits, and maintain confidentiality Capable of
lifting equipment, traveling, and working on-site or in the field
High School Diploma or GED required Attendance is mandatory for the
first 90 days R&E Nurse Preferred Qualifications Knowledge of
InterQual criteria, ICD-9 CM, CPT coding Familiarity with PROMISe
or Medicaid billing systems Experience in utilization review or
quality management is highly desirable If you think this R&E
Nurse – Med Care Services – Intermediate position is a good fit for
you, please reach out to me – feel free to call, e-mail, or apply
to this posting!
Keywords: , Altoona , R E Nurse- Med Care Services, Healthcare , Pittsburgh, Pennsylvania
