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Review Vacancy

Date Posted 04/11/18

Applications Due04/26/18

Vacancy ID51372

AgencyInsurance Fund, State

TitleMedical Care Representative

Occupational CategoryHealth Care, Human/Social Services

Salary Grade19

Bargaining UnitPS&T - Professional, Scientific, and Technical (PEF)

Salary RangeFrom $59671 to $75785 Annually

Employment Type Full-Time

Appointment Type Permanent

Jurisdictional Class Competitive Class

Travel Percentage 20%

Workweek Mon-Fri

Hours Per Week 37.50

Workday

From 9 AM

To 5 PM

Flextime allowed? Yes

Mandatory overtime? No

Compressed workweek allowed? Yes

Telecommuting allowed? No

County Onondaga

Street Address 1045 7th North Street

City Liverpool

StateNY

Zip Code13088

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.

Open-competitive List Minimum Qualifications: On or before the date of filing your application, you must have a current license, and be registered to practice as a registered professional nurse in New York State. In addition, you must have had three years of registered nursing experience in the following areas: rehabilitation, medical/surgical, public health, community health, visiting nursing, occupational health, utilization review, or review of medical records from hospitals for appropriate ICD9 or 10/DRG/PAS/CPT* coding.

*International Classification of Diseases - 9th or 10th Volume/Diagnostic Related Groups/Products of Ambulatory Surgery/Current Procedural Terminology.

Substitution: A Nurse Practitioner License in any of the areas listed above, or certification as a certified coder, may be substituted for one year of the qualifying experience.

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 Candidates who are not current state employees are encouraged to
apply by completing the NYS application form and submitting via email to hr@nysif.com or mailing to:
NYS Insurance Fund, Personnel Office
15 Computer Drive West
Albany, NY 12205

The New York State application form can be found here:
https://www.cs.ny.gov/announ/applications.cfm.

Some positions may require additional credentials or a background check to verify your identity.

Name Lynn Hausman

Telephone

Fax 518-437-1618

Email Address hr@nysif.com

Address

Street 15 Computer Drive West

City Albany

State NY

Zip Code 12205

 

Notes on ApplyingIf applying for transfer, please email your resume and cover letter to hr@nysif.com, including the position title and Vacancy ID number in the subject line.

Candidates who are not current state employees are encouraged to apply for eligibility for completing the NYS application form and submitting via email to hr@nysif.com or mailing to:
NYS Insurance Fund, Personnel Office
15 Computer Drive West
Albany, NY 12205

The New York State application form can be found here:
https://www.cs.ny.gov/announ/applications.cfm. Please also note the following important instructions included in the exam announcement when completing this application: "It is essential that you describe your education and experience as completely as possible on the NYS-APP Open Competitive Examination Application form. Ambiguity, vagueness, or omissions will not be decided in your favor. Do NOT send resumes. If you need more space, attach additional 8 1/2" x 11" sheets, following the same format used on the application form."

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