Commonwealth of Pennsylvania
The Department of Human Services (DHS) is seeking a dynamic and detail-oriented Medical Records Examiner to join our dedicated Division of Clinical Review team. The role involves reviewing electronic forms and medical records to determine eligibility and medical necessity for behavioral health services and nursing facility referrals.
Responsibilities
Conduct reviews of electronic forms and medical records to assess eligibility and medical necessity of behavioral health services and nursing facility referrals.
Make determinations related to behavioral health service requests for prior authorizations of Intensive Behavioral Health Services (IBHS) for individuals under age 21.
Review individuals with mental illness who are being considered for admission into a nursing facility.
Interpret and apply state and federal regulations, bulletins, and policies to ensure requested services are appropriate and/or compensable for reimbursement by the PA Medical Fee‑for‑Service program.
Collaborate regularly with co‑workers, unit supervisors, and the department’s consulting physicians while maintaining a high degree of independence in work.
Work Schedule and Additional Information
Full‑time employment, 37.5 hours per week.
Work hours 7:00 AM to 3:00 PM, Monday–Friday, with a 30‑minute lunch break.
Free parking available.
Telework opportunity: up to three days per week from an approved Pennsylvania location with a securely configured high‑speed internet connection.
Salary may be non‑negotiable in some cases.
Qualifications
Minimum three years of professional experience in medical assistance, health care services, or human services; or an equivalent combination of experience and training.
Active authorization to practice as a Registered Nurse in Pennsylvania.
If holding a temporary practice permit, obtain licensure as a Registered Nurse within the one‑year period defined by the Pennsylvania State Board of Nursing.
PA residency requirement must be met.
Ability to perform essential job functions.
How to Apply
Resumes and cover letters are not reviewed; only information provided on the application is used to determine eligibility.
Attach college transcripts (official or unofficial) if claiming education on supplemental application questions.
The application must be submitted by the posting closing date; late applications are not accepted.
Failure to comply with application requirements may eliminate you from consideration.
Veterans
Pennsylvania law provides employment preference for qualified veterans for many state and local government jobs.
Disability Accommodations
Telecommunications Relay Service (TRS): 711 for hearing and speech disabilities.
Applicants needing accommodations due to a disability should discuss requests with the interviewer in advance of the interview date.
Equal Employment Opportunity 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.
Examination Information
Completing the application, including all supplemental questions, serves as the exam for this position; no additional written exam is required.
The score is based on the detailed information provided on the application.
Your score is valid only for this specific posting.
Inaccurate information may lower your score or result in disqualification.
You may only apply/test once for this posting.
Results will be provided via email.
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Responsibilities
Conduct reviews of electronic forms and medical records to assess eligibility and medical necessity of behavioral health services and nursing facility referrals.
Make determinations related to behavioral health service requests for prior authorizations of Intensive Behavioral Health Services (IBHS) for individuals under age 21.
Review individuals with mental illness who are being considered for admission into a nursing facility.
Interpret and apply state and federal regulations, bulletins, and policies to ensure requested services are appropriate and/or compensable for reimbursement by the PA Medical Fee‑for‑Service program.
Collaborate regularly with co‑workers, unit supervisors, and the department’s consulting physicians while maintaining a high degree of independence in work.
Work Schedule and Additional Information
Full‑time employment, 37.5 hours per week.
Work hours 7:00 AM to 3:00 PM, Monday–Friday, with a 30‑minute lunch break.
Free parking available.
Telework opportunity: up to three days per week from an approved Pennsylvania location with a securely configured high‑speed internet connection.
Salary may be non‑negotiable in some cases.
Qualifications
Minimum three years of professional experience in medical assistance, health care services, or human services; or an equivalent combination of experience and training.
Active authorization to practice as a Registered Nurse in Pennsylvania.
If holding a temporary practice permit, obtain licensure as a Registered Nurse within the one‑year period defined by the Pennsylvania State Board of Nursing.
PA residency requirement must be met.
Ability to perform essential job functions.
How to Apply
Resumes and cover letters are not reviewed; only information provided on the application is used to determine eligibility.
Attach college transcripts (official or unofficial) if claiming education on supplemental application questions.
The application must be submitted by the posting closing date; late applications are not accepted.
Failure to comply with application requirements may eliminate you from consideration.
Veterans
Pennsylvania law provides employment preference for qualified veterans for many state and local government jobs.
Disability Accommodations
Telecommunications Relay Service (TRS): 711 for hearing and speech disabilities.
Applicants needing accommodations due to a disability should discuss requests with the interviewer in advance of the interview date.
Equal Employment Opportunity 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.
Examination Information
Completing the application, including all supplemental questions, serves as the exam for this position; no additional written exam is required.
The score is based on the detailed information provided on the application.
Your score is valid only for this specific posting.
Inaccurate information may lower your score or result in disqualification.
You may only apply/test once for this posting.
Results will be provided via email.
#J-18808-Ljbffr