Health Care Surveyor 4 (Nursing) (NY HELPS) - 80146

About the role

The Office of Health Insurance Programs, within the Division of Medical & Dental Directors, in the Bureau for Children with Medical Complexity is seeking a Health Care Surveyor 4 (Nursing) position. The Bureau for Children with Medical Complexity (BCMC) is responsible for addressing the needs of children with medical complexity and overseeing Medicaid services that support this population. The Health Care Surveyor 4 (Nursing) will serve as a unit manager within BCMC and will oversee the Medically Fragile Waiver Enrollment Unit and the Environmental Modification, Vehicle Modification, Assistive Technology, and Financial Management Services (EMOD/VMOD/AT/FMS) Unit.

Responsibilities

• Oversee day-to-day operations of the assigned units, including staff, workloads, and program activities;
• Supervise nursing and clinical review staff responsible for waiver enrollment, service reviews, and regulatory and quality assurance activities;
• Oversee clinical reviews, complaints, incidents, prior approvals, and claims review activities;
• Ensure compliance with applicable federal and state requirements, Medicaid policies, and standards of clinical practice;
• Use program data and feedback from children and families, healthcare providers, and other stakeholders to identify needs and opportunities for program development and quality improvement;
• Lead or support innovative approaches to improve access, service