Rem Quality Improvement Nurse

Position: REM QUALITY IMPROVEMENT NURSE
GRADE

20

LOCATION OF POSITION

MDH - Division of Children's Services 201 W. Preston Street Baltimore, MD 21201

Main Purpose of Job

The main purpose of this Medical Services Reviewing Nurse II position is to perform quality improvement activities within the Rare and Expensive Case Management (REM) program. This position works directly with the REM case management contractor to assure that the REM enrollees are receiving appropriate case management and medical services per the REM contract requirements. The review nurse communicates with the REM case management contractors, and/or the REM case managers regarding potential obstacles to care (reportable events).

MINIMUM QUALIFICATIONS

Education:

A Bachelor's degree in Nursing or a related field from an accredited college or university.

Experience:

One year of experience reviewing medical services claims to ensure that the nature and quality of services are in accordance with State and federal regulations.  Notes:
1. Candidates may substitute two years of experience as a Registered Nursefor the required education.  
2.Candidates may substitute U.S. Armed Forces military service experience as a commissioned officer in Nursing classifications or Nursing specialty codes in the Nursing field of work on a year-for-year basis for the required education.

DESIRED OR PREFERRED QUALIFICATIONS

The desired candidate should possess the following:  Previous experience in case management services and quality assurance review and reporting.  

Experience with Maryland Medicaid Information System Subsystems (MMIS) and/or LTSS.  

Experience with applicable state and federal laws, regulations and requirements.  

Experience with Microsoft Office and Google applications.  

Experience with Institutional Billing and Medicaid Waiver programs.

LICENSES, REGISTRATIONS AND CERTIFICATIONS

1. Candidates for positions in this classification must possess a current license as a Registered Nurse from the Maryland State Board of Nursing, 4140 Patterson Avenue, Baltimore, Maryland 21215 or possess a current multi-state licensein party states that candidates have declared as primary states of residence.  
2. Employees in this classification may be assigned duties which require the operation of a motor vehicle. Employees assigned such duties will be required to possess a motor vehicle operator's license valid in the State of Maryland.  

SELECTION PROCESS

Applicants who meet the minimum (and selective) qualifications will be included in further evaluation. The evaluation may be a rating of your application based on your education, training and experience as they relate to the requirements of the position.

Therefore, it is essential that you provide complete and accurate information on your application.

Please report all related education, experience, dates and hours of work.

Clearly indicate your college degree and major on your application, if applicable. For education obtained outside the U.S., any job offer will be contingent on the candidate providing an evaluation for equivalency by a foreign credential evaluation service prior to starting employment (and may be requested prior to interview). Complete applications must be submitted by the closing date.

Information submitted after this date will not be added. Incorrect application forms will not be accepted.

Resumes will not be accepted in lieu of a completed application. Candidates may remain on the certified eligible list for a period of at least one year. The resulting certified eligible list for this recruitment may be used for similar positions in this or other State agencies.

BENEFITS

STATE OF MARYLAND BENEFITS

FURTHER INSTRUCTIONS

Online applications are highly recommended. However, if you are unable to apply online,the paper application (and supplemental questionnaire) may be submitted to MDH, Recruitment and Selection Division, 201 W. Preston St., Room 114-B, Baltimore, MD 21201.Paper application materials must be received by 5 pm, close of business, on the closing date for the recruitment, no postmarks will be accepted. If additional information is required, the preferred method is to upload.

If you are unable to upload, please fax the requested…