Registered Nurse II
Location: South Carolina
Description: State of South Carolina is at the momment seeking for Registered Nurse II right now, this position will be placed in South Carolina. More complete informations about this position opportunity please read the description below. Identifies waste, fraud and abuse in the Medicaid program by performing reviews on providers of Medicaid services. Conducts evaluation and analysis of physician and medical related specialty Medicaid provider statistical profiles and Detail Claims Reports (DCRs) generated by the current SURS/Medstat system. Analyzes special reports or MMIS data as it pertains to case development. Evaluates paid claims history data. Develops case reviews. Reviews all information received and do a comparison review between the Medicaid paid claims, applicable Medicaid rules, regulations and policy and all documentation or information obtained. Verifies appropriateness and medical necessity of services billed to Medicaid. Coordinates case actions with supervisor, program area staff and medical consultants. Presents cases in program area meetings or Review Committee. Completes case analysis by preparing provider notification of results/findings letters. Identifies and describes the provider's aberrant billings, cite the policy which validates the errors and provide recommendations to prevent the improper billing from occurring in the future. Sends educational letters as appropriate. Monitors case progression at 10 day and 35 day intervals and respond to provider as necessary.
Minimum and Additional Requirements:
A bachelor's degree in nursing, or diploma in nursing with four (4) year experience as a registered nurse, or an associate's degree in nursing with two (2) years experience as a registered nurse. Graduation from an accredited school of nursing and related nursing experience. NECESSARY SPECIAL REQUIREMENT: Current licensure as a Registered Nurse by the South Carolina Board of Nursing. Must maintain a current SC Registered Nurse license. Valid driver’s license required and must have access to a personal vehicle as needed.
Preferred Qualifications:
Three (3) years’ experience in nursing, health or a medical related specialty. Considerable knowledge of contemporary health care diagnosis and standard methods of treatment and therapy. Thorough knowledge of health care trends and practices. Nursing expertise in order to conduct comprehensive reviews of medical services. Ability to communicate effectively. Working knowledge of a personal computer.
Additional Comments:
Please complete the State application to include all current and previous work history and education. A resume will not be accepted nor reviewed to determine if an applicant has met the qualifications for the position. Supplemental questions are considered part of your official application for qualification purposes. All applicants must apply on line. All correspondence from the Office of Human Resources will be through electronic mail with the exception of a letter of offer.
This position is located in the Division of Program Integrity.
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If you were eligible to this position, please email us your resume, with salary requirements and a resume to State of South Carolina.
If you interested on this position just click on the Apply button, you will be redirected to the official website
This position starts available on: Wed, 01 Aug 2012 05:18:10 GMT