Review Vacancy
AgencyMedicaid Inspector General, NYS Office of the
TitleHospital Nursing Services Consultant
Occupational CategoryHealth Care, Human/Social Services
Bargaining UnitPS&T - Professional, Scientific, and Technical (PEF)
Salary RangeFrom $64302 to $81415 Annually
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 overpayments 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.
The position requires an individual capable of critical thinking, have strong organizational skills, and excellent writing skills.
Additional Comments Condition of Employment: Permanent, Full Time, and Competitive. Filling of this position is contingent upon Division of Budget waiver approval.
Some positions may require additional credentials or a background check to verify your identity.