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Minimum Qualifications Transfer Candidates: You must be a current NYS employee with permanent or contingent-permanent status as a Hospital Nursing Services Consultant OR New York State employee with one year of permanent or contingent-permanent service in a Grade 20 title or higher deemed eligible for transfer to a Hospital Nursing Services Consultant under Section 70.1 of the Civil Service Law.
Open Competitive Candidates: Reachable on the Hospital Nursing Services Consultant/Community Nursing Services Consultant (Home Health Services) list.
Duties Description The Division of Medicaid Investigations (DMI) ensures the integrity of the Medicaid program by conducting investigations, recovering over payments and implementing administrative sanctions against providers. The incumbent of this position will work with other nurses of the State Medical Review Team (SMRT) within the Recipient Restriction Program within DMI. Nurses in SMRT perform reviews of inappropriate receipt or payment of care or services for recipients under the Medicaid program and recommend recipients for restriction.
The SMRT nurses review recipients targeted either from summary profile reports obtained by running exception criteria against paid Medicaid claims data, or from referrals of individuals from other outside sources. The nurses prepare written summary reports of the medical care and services paid for on behalf of the recipient which exhibits aberrations sufficient to restrict the individual. In the process of conducting SMRT reviews, any information relative to aberrant practices by providers or fraudulent practices by recipients will be referred to other units within DMI to further ensure the enhancement of the integrity of the Medicaid program.
The position requires an individual capable of critical thinking. The ideal candidate will also have strong organizational and writing skills.
Some positions may require additional credentials or a background check to verify your identity.