Medical Records Examiner

Are you a Registered Nurse eager to leverage your expertise in assessing clinical information to ensure that qualified medical assistance recipients receive high-quality care? If so, consider becoming a Medical Records Examiner with the Bureau of Managed Care, Division of Quality and Special Needs Coordination. In this role, you will have the opportunity to assess the medical necessity, appropriateness, quality, quantity, and sufficiency of care provided to recipients under the Medical Assistance Program. Do not miss out on this exceptional opportunity in Medicaid case review, apply today!

In this position, you will act as a professional staff member within the Bureau of Managed Care Operations (BMCO), reporting directly to the Clinical Operations Supervisor in the Clinical Operations Section of the Division of Quality and Special Needs Coordination (DQSNC). The role is based in the central office and may necessitate travel across Pennsylvania for meetings and on-site monitoring activities. You will represent the DQSNC and hold clinical accountability for the continuous monitoring and assessment of the daily operations related to Quality Management, Utilization Management, and Quality Improvement (QM/UM/QI) for the designated HealthChoices Managed Care Organization (MCO). Furthermore, you will contribute clinical expertise as part of a multidisciplinary contract management monitoring team, as appointed by the Division Director of DQSNC and the Bureau Director of BMCO. Additionally, this role involves providing advisory and consultative support to other bureaus within the Department of Human Services (DHS) and various state agencies.

Interested in learning more? Additional details regarding this position can be found in the position description.

Work Schedule and Additional Information:

• Full-time employment
• Work hours are 8:00 AM to 4:00 PM, Monday - Friday, with a 30-minute lunch.
• Telework: You may have the opportunity to work from home (telework) part-time, with a minimum of 1 day per month in the office. In order to telework, you must have a securely configured high-speed internet connection and work from an approved location inside Pennsylvania. If you are unable to telework, you will have the option to report to the headquarters office in Harrisburg.
• Salary: In some cases, the starting salary may be non-negotiable.
• You will receive further communication regarding this position via email. Check your email, including spam/junk folders, for these notices.

QUALIFICATIONS

Minimum Experience and Training Requirements:

• Three years of professional experience in the field of medical assistance, health care services, or human services; or
• An equivalent combination of experience and training.

Special Requirements:

• This position requires active authorization to practice as a Registered Nurse in Pennsylvania.
• This position requires employees possessing an active temporary practice permit, you must obtain licensure as a Registered Nurse within the one (1) year period defined by the Pennsylvania State Board of Nursing.
• This position requires possession of an active non-commercial Pennsylvania Class C Driver's License or equivalent.

Other Requirements:

• You must meet the PA residency requirement. For more information on ways to meet PA residency requirements, follow the link and click on Residency.
  
• You must be able to perform essential job functions.

How to Apply:

• Resumes, cover letters, and similar documents will not be reviewed, and the information contained therein will not be considered for the purposes of determining your eligibility for the position. Information to support your eligibility for the position must be provided on the application (i.e., relevant, detailed experience/education).
• If you are claiming education in your answers to the supplemental application questions, you must attach a copy of your college transcripts for your claim to be accepted toward meeting the minimum requirements. Unofficial transcripts are acceptable.
• Your application must be submitted by the posting closing date. Late applications and other required materials will not be accepted.
• Failure to comply with the above application requirements may eliminate you from consideration for this position.

Veterans:

• Pennsylvania law (51 Pa. C.S. *7103) provides employment preference for qualified veterans for appointment to many state and local government jobs. To learn more about employment preferences for veterans, go to www.employment.pa.gov/Additional%20Info/Pages/default.aspx and click the Veterans' Preference tab or contact us at ra-cs-vetpreference@pa.gov.

Telecommunications Relay Service (TRS):

• 711 (hearing and speech disabilities or other individuals).

If you are contacted for an interview and need accommodations due to a disability, please discuss your request for accommodations with the interviewer in advance of your interview date.

The Commonwealth is an equal employment opportunity employer and is committed to a diverse workforce. The Commonwealth values inclusion as we seek to recruit, develop, and retain the most qualified people to serve the citizens of Pennsylvania. The Commonwealth does not discriminate on the basis of race, color, religious creed, ancestry, union membership, age, gender, sexual orientation, gender identity or expression, national origin, AIDS or HIV status, disability, or any other categories protected by applicable federal or state law. All diverse candidates are encouraged to apply.

• Completing the application, including all supplemental questions, serves as your exam for this position. No additional exam is required at a test center (also referred to as a written exam).
• Your score is based on the detailed information you provide on your application and in response to the supplemental questions.
• Your score is valid for this specific posting only.
• You must provide complete and accurate information or:
  • your score may be lower than deserved.
  • you may be disqualified.
• You may only apply/test once for this posting.
• Your results will be provided via email.