Registered Nurse 2 (Medical Care)

Candidates must have a current Registered Nurse 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.
The ideal candidate should have excellent time management and teamwork skills, as well as the ability to work independently.

Reporting to a Registered Nurse supervisor, Registered Nurse 2 (Medical Care) positions at NYSIF are responsible for coordinating 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. Each Registered Nurse 2 will be assigned to one of the following focused teams: claimant outreach/accelerated care plan catastrophic and/or high cost claims team, prior authorization team, or claims management and consulting team. Duties will include, but not be limited to:

• Contact claimants and potentially providers, facilities, families, employers, etc. based on the claimant's medical status.
• Serve as resources to the claims staff in providing effective medical knowledge and management of these claims.
• Evaluate and authorize or deny prior authorizations for medications and durable medical equipment.
• Testify at trials and other official proceedings, when necessary, and introduction of evidence at trial.
• Utilize multiple complex computer programs and documentation to complete duties as necessary.
• Early intervention of medically complex claims to decrease exposure and provide increased customer satisfaction.
• Perform Utilization Review of DME, DRG, EAPG and complex bills and payments.
• Review medication usage and treatment records to identify anomalies in medical treatment plans including excessive treatment, excessive prescription medications or plans inconsistent with the claimed injury(s).
• Provide analyses of in-patient and out-patient, home care, long-term care management of the injured worker.
• Identify and manage high medical exposure claims for NYSIF.