Review Vacancy
TitleMedical Care Representative
Occupational CategoryHealth Care, Human/Social Services
Bargaining UnitPS&T - Professional, Scientific, and Technical (PEF)
Salary RangeFrom $57354 to $72841 Annually
Minimum Qualifications Reachable on current open competitive Civil Service list for this title or one year of permanent, competitive class service as a Medical Care Representative.
Duties Description Medical Care Representatives (MCRs) at the New York State Insurance Fund coordinate global case management of high-cost complex cases and are an extensive resource/mentor of the NYS Workers’ Compensation Board Medical Treatment Guidelines for Claims Service Managers and other Claims staff. The incumbent will be extensively involved in assessing and monitoring opioid usage as well as instrumental in the preparation for litigation in chronic pain management and other medically-related issues. Duties will include, but are not limited to: Manage daily medication prior authorizations through our Pharmacy Billing Manager intermediary and perform weekly audits on medication usage. Provide in-patient and out-patient, home care, long-term care management of the injured worker. Perform Utilization Review of DME, DRG, EAPG and complex bills and payments. Communicate with medical providers and vendors regarding medical aspects of claims. Utilize multiple complex computer programs and documentation to complete duties as necessary. The ideal candidate should have excellent time management and teamwork skills, as well as the ability to work independently.
Additional Comments To apply, please send your resume and cover letter to hr@nysif.com. Please include the Vacancy ID number in your subject line.
Some positions may require additional credentials or a background check to verify your identity.