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Job title: Hospital Nursing Services Consultant
Company: Department of Homeland Security
Job description: 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. This position may be designated 55 b/c and is subject to verification of applicant eligibility.
Duties Description This position will work with other nurse members of the State Medical Review Team (SMRT) with the Recipient Restriction Program within the Division of Medicaid Investigations. The State Medical Review Team (SMRT), as defined in regulation, performs nurse reviews of inappropriate receipt or payment of care or services for recipients under the Medicaid program and recommends 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 HNSC 2 ensures concise and accurate reviews are completed in a timely manner and recommends changes to the exception criteria used to run control files for targeted recipients who abuse the Medicaid System.
Additional Comments Filling of this position is contingent upon Division of Budget waiver approval. Ideal candidate should be able to review claims details and determine medical
appropriateness of care.
Some positions may require additional credentials or a background check to verify your identity.
Expected salary: $69603 – 88124 per year
Location: Albany, NY
Job date: Thu, 05 Aug 2021 00:18:57 GMT
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