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Medical Care Representative

Company: New York State Civil Service
Location: Melville
Posted on: May 3, 2021

Job Description:

Minimum Qualifications Reachable on current open-competitive Civil Service list for this title or one year of permanent, competitive class service as a Medical Care Representative. As this title is filled by Continuous Recruitment examination, you must complete a NYS-application form to apply for list eligibility. Please visit the Department of Civil Service website for more information on how to apply here: Open-competitive List Minimum Qualifications: On or before the date of filing your application, you must have a current 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/CPTcoding. 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. ## Duties Description Medical Care Representatives (MCRs) at the New York State Insurance Fund coordinate 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. The incumbent will be extensively involved in assessing and monitoring opioid usage as well as instrumental in the preparation for litigation in chronic pain management and other medically-related issues. Duties will include, but are not limited to: Manage daily medication prior authorizations through our Pharmacy Billing Manager intermediary and perform weekly audits on medication usage. Provide in-patient and out-patient, home care, long-term care management of the injured worker. Perform Utilization Review of DME, DRG, EAPG and complex bills and payments. Communicate with medical providers and vendors regarding medical aspects of claims. Utilize multiple complex computer programs and documentation to complete duties as necessary. The ideal candidate should have excellent time management and teamwork skills, as well as the ability to work independently. ## Additional Comments Candidates who are not current state employees are encouraged to apply by completing the NYS application form and submitting via email to or mailing to: NYS Insurance Fund, Personnel Office 15 Computer Drive West Albany, NY 12205 The New York State application form can be found here: ## Notes on Applying Candidates should email a resume and cover letter to . Candidates may also mail their application to 15 Computer Drive West, Albany, NY 12205 or fax to 518-437-1618. Please include the position title and Vacancy ID number on your cover letter.Date Posted: 04/19/21 Applications Due: 05/04/21 Vacancy ID: 86101 Agency: Insurance Fund, State Title: Medical Care Representative Occupational Category: Health Care, Human/Social Services Salary Grade: 19 Bargaining Unit: PS&T - Professional, Scientific, and Technical (PEF) Salary Range: From $59671 to $75785 Annually Employment Type: Full-Time Appointment Type: Permanent Jurisdictional Class: Competitive Class Travel Percentage: 20% Workweek: Mon-Fri Hours Per Week: 37.50 From: 9 AM To: 5 PM Flextime allowed?: Yes Mandatory overtime?: No Compressed workweek allowed?: Yes Telecommuting allowed?: No County: Nassau City: Albany State: NY Zip Code: 12205 Name: Lynn Hausman Fax: 518-437-1618 Email Address: Street Address: 8 Corporate Center Drive Street: 15 Computer Drive West

Keywords: New York State Civil Service, New Haven , Medical Care Representative, Other , Melville, Connecticut

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