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Health Care Surveyor 2 Nursing (2 Positions)
| Company | Medicaid Inspector General, NYS Office of the |
| Address | , Albany, 12204, Ny |
| Employment type | FULL_TIME |
| Salary | $97,029 - $106,140 a year |
| Expires | 2023-07-16 |
| Posted at | 1 year ago |
Looking for a nursing dream job with no patient contact?!?! No mandatory overtime, evenings, nights or weekends? Daytime hours, opportunity to work from home, lots of vacation and great benefits, including a pension? Look no further! You’ve worked on your feet for years - continue to put your skills to use as a Health Care Surveyor 2 (Nursing) with NYS Office of Medicaid Inspector General. From now on be home in time for dinner!
License and current NYS registration as a Professional Nurse and three years of post-licensure professional nursing experience, at least two years of which must have been professional clinical nursing experience in a licensed health care facility.
Qualifying health facilities and programs include hospitals, nursing homes, adult homes, ambulatory care facilities, managed care organizations, psychiatric centers, diagnostic and treatment clinics, home health agencies, assisted living facilities, hospice, renal dialysis units, alcoholism and substance abuse treatment facilities, developmental centers and community-based programs for the mentally ill and developmentally disabled. Experience as an RN in a private doctor’s office or group practice, or as a school nurse is NOT considered qualifying.
Substitution: A bachelor’s or master’s degree in Nursing can be substituted for one year of the required general nursing experience.
Preferred Qualifications:
Bachelor’s degree in Nursing. Experience in the review of medical records and utilization review. Previous Prepayment Claims Review experience is a plus. Basic computer skills such as Microsoft Word, Excel, Access, and Outlook. A clear understanding of the NYS Medical Medicaid Program rules, regulations, and guidelines. Excellent communication and interpersonal skills.
- Providing official expert testimony on behalf of New York State during administrative hearings and court proceedings.
- Assisting in building criteria to capture and process medical claims.
- Utilizing professional judgment to document and critique the quality of care provided to the Medicaid patients of identified Medicaid Providers.
- Manually reviewing treatment records for identified Medical System Match and Recovery Projects.
- Assisting with medical research-related projects.
- Performing research and data collection to support prepayment review actions.
- Monitoring the billing patterns and practices of identified medical providers.
- Providing assistance in targeting and data review.
- Performing review and processing of pending professional medical claims, assuring appropriate determinations.
- Utilizing professional medical expertise to provide OMIG with a critique of a Provider’s practice when suspected inappropriate performance is identified.
- Defending the professional judgment utilized during claim reviews, system match projects, and audits of identified Medicaid Providers.
- Travelling, if necessary, to consult, examine records or documents, and testify.
- Communicating orally and in writing with Medical Medicaid Providers, OMIG legal staff, independent peers, other agencies, the provider community, and their legal counsel as necessary.
- Providing professional expertise to OMIG staff as requested.
- Preparing Provider review summaries and referrals for action based on NYS Medical Medicaid Rules, Regulations, Policies, and Guidelines.
- Working with OMIG program and system staff as necessary.
- Posted salary range includes the statutory hiring rate at Step 4 and job rate for PS&T Grade 20 ($77,029 - $86,140) and an additional Geographic Pay Differential of $20,000.
**The Department of Civil Service has developed the Hiring for Emergency Limited Placement Program (HELP), which is a streamlined program that allows appointment to this title and others without examination. This program will be in existence from April 1, 2023, through March 31, 2024.
For the duration of the HELP Program, this title will be filled via permanent non-competitive appointment, which means no examination is required but all candidates must meet the minimum qualifications of the titles for which they apply. At the close of the HELP program (March 31, 2024), employees hired under the HELP Program will have their non-competitive employment status converted to competitive status. Employees will then be afforded with all the same rights and privileges of competitive class employees of New York State.
Benefits of Working for NYS
Generous benefits package, worth 65% of salary, including:
Holiday & Paid Time Off
- Up to Thirteen (13) days of paid vacation leave annually
- Up to Thirteen (13) days of paid sick leave annually for PEF/CSEA
- Up to three (3) days of professional leave annually to participate in professional development
- Up to Five (5) days of paid personal leave annually
- Thirteen (13) paid holidays annually
Health Care Benefits
- Eligible employees and dependents can pick from a variety of affordable health insurance programs
- Family dental and vision benefits at no additional cost
Additional Benefits
- New York State Employees’ Retirement System (ERS) Membership
- Access to NY 529 and NY ABLE College Savings Programs, as well as U.S. Savings Bonds
- And many more.
- Public Service Loan Forgiveness (PSLF)
- NYS Deferred Compensation
Free parking available.
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