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MEDICAL SERVICES REVIEWING NURSE II

Recruitment #18-004251-0003

Introduction

Potential bonuses for hiring and retention may be available for this position. 

GRADE

17

LOCATION OF POSITION

PHPA, Center for Cancer Prevention and Control, Baltimore, MD

Main Purpose of Job

The main purpose of this position is to serve as a medical services review nurse, providing professional support for the administration of the Breast and Cervical Cancer Diagnosis and Treatment Program. This position is responsible for reviewing and processing medical claims that require medical review, performing prior authorization and retroactive review of services to determine medical necessity and relationship to breast and cervical cancer diagnosis and treatment, providing clinical and technical assistance to local health department nurses and other clinical staff, reviewing patient applications to determine medical eligibility, and providing consultation and technical assistance to health care providers regarding covered services and reimbursement.

MINIMUM QUALIFICATIONS

Education: Possession of 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.

Note: 

1. Two years of experience as a Registered Nurse may be substituted for 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 successful applicant should be computer proficient and possess excellent organizational skills.  Knowledge regarding ICD-10 and CPT coding and breast and cervical cancer diagnosis and treatment is desirable.

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.  A copy of your current license or license verification should accompany your application. 

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. Candidates may remain on the certified eligible list for a period of at least one year.

Online applications are highly recommended. However, if you are unable to apply online, the paper application may be submitted to MDH, Recruitment and Selection Division, 201 W. Preston St., Room 114-B, Baltimore, MD 21201.  The paper application must be received by 5 pm, close of business, on the closing date for the recruitment, no postmarks will be accepted.

Incorrect application forms will not be accepted.

If additional information is required, the preferred method is to upload.  If unable to upload, please fax requested information only to 410-333-5689.  Only additional materials that are required will be accepted for this recruitment. All additional information must be received by the closing date and time.

Resumes will not be accepted in lieu of a completed application.

For questions regarding this recruitment, please contact the MDH Recruitment and Selection Division at 410-767-1251. 

If you are having difficulty with your user account or have general questions about the online application system, please contact the MD Department of Budget and Management, Recruitment and Examination Division at 410-767-4850 or Application.Help@maryland.gov

Appropriate accommodations for individuals with disabilities are available upon request by calling: 410-767-1251 or MD TTY Relay Service 1-800-735-2258.

BENEFITS

FURTHER INSTRUCTIONS

As an equal opportunity employer, Maryland is committed to recruiting, retaining and promoting employees who are reflective of the State’s diversity. People with disabilities and bilingual candidates are encouraged to apply. We thank our Veterans for their service to our country.

The resulting certified eligible list for this recruitment may be used for similar positions in this or other State agencies.




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