COMPLEX MEDICAL CASE REVIEWER

About the role

The Office of Liens and Trusts (OLT) is recruiting for one Supervisor of Nurses I to function as a Complex Medical Case Reviewer. This position will conduct medical reviews and analyses of claims to calculate injury-related Medicaid liens pursuant to SSL-104b on cases involving medical malpractice, mass medical torts, lead paint poisoning, traumatic brain injury, or other catastrophic or medically complex cases.

Responsibilities

• Conduct medical reviews and analyses claims to calculate injury related Medicaid liens pursuant to SSL-104b on cases involving medical malpractice, mass medical torts, lead paint poisoning, traumatic brain injury, or other catastrophic or medically complex cases.
• Consult Medicaid payment records, bills of particulars, and other legal or medical documents provided. Update database system with notes and other records to support calculations.
• Draft appropriate correspondence including statements of aid paid, notice of lien letter, affidavits and lien agreement letters. Fax and/or mail correspondence to plaintiff attorneys, defense attorneys, and/or clients. When appropriate submit affidavit to court supporting lien calculations and conclusions.
• Communicate with plaintiff's counsel to obtain additional medical documentation or information. Negotiate repayment of the Medicaid lien with counsel.
• Testify in Court to defend and support the Department of Social Services' lien.

Requirements

• A valid New York State License and current registration to practice as a Registered Professional Nurse. This license must be maintained for the duration of employment.
• For Assignment Level I: In addition to meeting the license requirement above, candidates must have three years of full-time satisfactory experience as a Registered Nurse, two of which must have been in a supervisory capacity within a hospital or other appropriate setting.
• For Assignment Level II: In addition to meeting the license requirement above, candidates must: a) have completed a Psychiatric Nurse Practitioner or equivalent program registered or approved by the New York State Education Department; or b) have current certification as a Psychiatric Nurse Practitioner by a national certifying body recognized by the New York State Education Department. In addition, candidates must have three years of full-time satisfactory experience as a Registered Nurse, one of which must have been working in the capacity of Psychiatric Nurse Practitioner.

Qualifications

• Working knowledge of HRA/IREA systems, such as WMS, HRA Viewer, LexisNexis, IPAY, ICD 9 Codes, ICD 10 Codes, CPT Codes, DRG Codes, Medical coding/billing a plus
• Working knowledge of Word, Excel, PowerPoint
• Strong verbal and interpersonal communication skills

Benefits

• Public Service Loan Forgiveness
• New York City residency is generally required within 90 days of appointment. However, City Employees in certain titles who have worked for the City for 2 continuous years may also be eligible to reside in Nassau, Suffolk, Putnam, Westchester, Rockland, or Orange County.

Pay

Salary range: $75,000 - $90,000 annually

Schedule

HOURS/SHIFT: 9AM - 5PM

Supervisor of Nurses - 50960

Minimum Qualifications: A valid New York State License and current registration to practice as a Registered Professional Nurse. This license must be maintained for the duration of employment. AND: For Assignment Level I, in addition to meeting the license requirement above, candidates must have three years of full-time satisfactory experience as a Registered Nurse, two of which must have been in a supervisory capacity within a hospital or other appropriate setting. For Assignment Level II, in addition to meeting the license requirement above, candidates must: a) have completed a Psychiatric Nurse Practitioner or equivalent program registered or approved by the New York State Education Department; or b) have current certification as a Psychiatric Nurse Practitioner by a national certifying body recognized by the New York State Education Department. In addition, candidates must have three years of full-time satisfactory experience as a Registered Nurse, one of which must have been working in the capacity of Psychiatric Nurse Practitioner.

Preferred Skills

• Working knowledge of HRA/IREA systems, such as WMS, HRA Viewer, LexisNexis, IPAY, ICD 9 Codes, ICD 10 Codes, CPT Codes, DRG Codes, Medical coding/billing a plus
• Working knowledge of Word, Excel, PowerPoint
• Strong verbal and interpersonal communication skills

Additional Information

• The City of New York is an inclusive equal opportunity employer committed to recruiting and retaining a diverse workforce and providing a work environment that is free from discrimination and harassment based upon any legally protected status or protected characteristic, including but not limited to an individual's sex, race, color, ethnicity, national origin, age, religion, disability, sexual orientation, veteran status, gender identity, or pregnancy.