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Are you a registered nurse interested in preventing and detecting fraud and abuse within the PA Medical Assistance Program? The Bureau of Program Integrity currently has an open position in the Division of Program & Provider Compliance Hospital Based Section.

Through retrospective medical record reviews and claims analysis the RN will identify potential fraud waste and abuse and cite appropriate MA regulation violations to ensure appropriate high quality medical care is administered. Effective verbal and written communication as well as comprehension of regulations and policies are essential to notify providers stakeholders and administrative law judges of the retrospective review findings.

Additional details regarding the duties of this position may be found in the position description.

Work hours and additional information:

• Full-time employment.
• Hours of work: Monday through Friday 8:00 AM – 4:00 PM; 30 minute lunch.
• Teleworking: You may have the opportunity to work from home (telework) part-time. In order to telework you must have a securely configured high-speed internet connection. If you are unable to telework you will have the option to report to the headquarters office in Harrisburg.
• You will receive further communication regarding this position via email. Please check your email including spam 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 in the field of medical assistance health care services or human services.
• SPECIAL REQUIREMENT: All positions require an active license to practice as a Registered Nurse issued by the Pennsylvania State Board of Nursing; or possession of a non-renewable temporary practice permit issued by the Pennsylvania State Board of Nursing.
• SPECIAL REQUIREMENT: All employees having non-renewable temporary practice permits issued by the Pennsylvania State Board of Nursing must obtain licensure as a Registered Nurse Commonwealth of Pennsylvania 4 within the one (1) year period as defined by the Pennsylvania State Board of Nursing.
• Must meet PA residency requirement – For more information on ways to meet PA residency requirements follow the link and click on Residency.
• Do not submit resumes cover letters and similar documents. These documents will not be reviewed and the information contained therein will not be considered for the purposes of determining your eligibility for the position or to determine your score. Information to support your eligibility for the position must be provided on the application (i.e. relevant detailed experience/education).
• Must be able to perform essential job functions.

• 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:
  • you may be disqualified.
• You may only apply/test once for this posting.
• Your results will be provided via email.