Medicaid Review Nurse - Central Office
$83,200–$83,200 year
On-siteLincoln, Nebraska, United States
Job Summary
Manage and process all Medicaid applications for incarcerated individuals, coordinating eligibility, enrollment, authorizations, and continuity of care. Assist with applications and renewals, support hospital and discharge planning, and address coverage issues using nursing knowledge to identify reimbursable services and monitor expenditures. Perform quality control duties for internal and external medical services while adapting to changing priorities and assisting with additional duties as needed. Complete four to eight weeks of on-the-job training, submit to a security background check, and pass a pre-employment medical examination and drug test.
Required Qualifications
- A current license to practice as a Licensed Practical Nurse in Nebraska or authority based on the Nurse Licensure Compact to practice as a Licensed Practical Nurse in Nebraska
- Must possess a valid driver's license
- Must be able to lift up to 50 lbs. with assistance
- Must submit to security background check
- Applicants accepting a job offer must pass the pre-employment medical examination and a drug test
- Must successfully complete the fully paid NDCS Pre-service Training Program
Desired Qualifications
- Demonstrates proficiency in data entry, including accurate and timely entry of information into applicable systems, spreadsheets, and databases
- Must possess strong keyboarding skills and the ability to maintain a high level of accuracy while processing information efficiently
- Prior experience working with Medicaid applications, eligibility determination, or Medicaid reimbursement processes
- Experience with utilization review, CQI processes, or peer review practices
- Experience using electronic health record, tracing systems, or medical claims databases
- Experience reviewing, processing, and tracking applications, medical records, or similar complex paperwork requiring attention to detail and accuracy
- Experience in correctional healthcare, public health, or working with justice-involved populations
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