Review Vacancy
AgencyMedicaid Inspector General, NYS Office of the
Occupational CategoryOther Professional Careers
Bargaining UnitPS&T - Professional, Scientific, and Technical (PEF)
Salary RangeFrom $75243 to $94834 Annually
Minimum Qualifications Current New York State employee with one year permanent or contingent permanent status as a Pharmacy Consultant, OR NYS employee with one year or more of permanent or contingent-permanent service in a title eligible to transfer under Section 70.1 of the Civil Service Law.
Duties Description The Division of Medicaid Investigations ensures the integrity of the Medicaid program by conducting investigations, recovering over payments and implementing administrative sanctions against providers or referral for criminal prosecution. The Pharmacy Consultant will function as a member of the State Medical Review Team (SMRT) which is required by regulation to review individual Medicaid recipients to determine whether they should be recommended for restriction. Individual recipients are targeted for review either through a review of summary profile reports obtained by running exception criteria against Medicaid paid claims data, or by receipt of referrals of individual recipients by outside sources. The incumbent of this position will be responsible for preparing written narratives detailing a summary of the pharmacological history of paid Medicaid claims related to expected and accepted drug and supply use. The review will determine overuse or misuse of services warranting the restriction of the recipient. In the process of conducting reviews, information of interest to other areas of the OMIG, such as forged prescriptions, inappropriate ordering by providers, and illegal or otherwise inappropriate actions by the recipients will be referred within the Office to increase the overall integrity of the Medicaid program.
Additional Comments Permanent, full-time, competitive. Filling of this position is pending a waiver approval by the Division of Budget. The Pharmacy Consultant position includes an additional $11,000 state-wide annual salary adjustment.
Some positions may require additional credentials or a background check to verify your identity.