Review Vacancy
AgencyMedicaid Inspector General, NYS Office of the
TitleHealth Care Surveyor 4 Nursing
Occupational CategoryHealth Care, Human/Social Services
Bargaining UnitPS&T - Professional, Scientific, and Technical (PEF)
Salary RangeFrom $122342 to $145980 Annually
Minimum Qualifications 70.1 Transfer Candidates: You must be a current NYS employee with one year of permanent or contingent-permanent service as a Health Care Surveyor 4, G-25 OR current NYS employee with one year of permanent or contingent-permanent competitive service in a qualified title and eligible for transfer to Health Care Surveyor 4 under Section 70.1 of the Civil Service Law.
Non-Competitive under the HELP program: possession of a license and current registration as a registered professional nurse in New York State; a bachelor’s degree in nursing; and four years of post-licensure, specialized professional administrative or professional clinical experience. One year of the experience must have been at a supervisory level.
Qualifying health facilities and programs include hospitals, nursing homes, adult homes, ambulatory care facilities, managed care organizations, psychiatric centers, diagnostic and treatment clinics, home health agencies, assisted living facilities, hospice, renal dialysis units, alcoholism and substance abuse treatment facilities, developmental centers, and community-based programs for the mentally ill and developmentally disabled.
Experience as an RN in a private doctor’s office or group practice, or as a school nurse is NOT considered qualifying.
PREFERRED QUALIFICATIONS:
Experience in detailed complex record reviews; supervisory experience; excellent written and verbal communication skills.
Duties Description The Division of Medicaid Investigations (DMI) ensures the integrity of the Medicaid program by conducting investigations, recovering overpayments, implementing administrative sanctions against providers and/or recipients. The incumbent of this position will work with other individuals in the Prepayment Claims Review and Dental Audits team and the Dental Investigations team. Duties include but are not limited to:
• Train, supervise and mentor staff; ensure the effective daily flow of work for each Prepayment Claims Review team.
• Mentor each team in the Prepayment Claims Review group.
• Complete detailed record and documentation reviews, claims processing, data gathering.
• Provide oversight and Provider education.
• Preparing Provider review summaries and referrals for action based on NYS Medical Medicaid Rules, Regulations, Policies, and Guidelines.
• Assisting with medical research-related projects.
• Participate in cross division collaborations within OMIG.
• Utilizing professional medical and dental expertise to provide OMIG with a critique of a Provider’s practice when suspected inappropriate performance is identified.
• Use eMedNY and FACTS for claim processing.
• Communicating orally and in writing with Medical and Dental Medicaid Providers, OMIG legal staff, independent peers, other agency, the provider community, and their legal counsel as necessary.
• Working with OMIG program and system staff as necessary.
• Travelling, if necessary, to consult, examine records or documents, and testify.
Additional Comments Permanent, Full Time, Non-Competitive. Free parking available. Minimal travel across New York State. Current licensure and registration to practice as a professional Nurse in New York State is necessary for continued employment as a Health Care Surveyor 4 Nursing. Action will be taken to remove you from your position if you fail to maintain licensure and registration.
*Posted salary range includes the statutory hiring rate at Step 4 and job rate for PS&T Grade 25 ($90,806 - $114,444) and an additional Geographic Pay Differential of $20,000.
**The Department of Civil Service has developed the Hiring for Emergency Limited Placement Program (HELP), which is a streamlined program that allows appointment to this title and others without examination. This program will be in existence from April 1, 2023, through March 31, 2024.
For the duration of the HELP program, this title will be filled via permanent, non-competitive appointment, which means no examination is required but all candidates must meet the minimum qualifications of the titles for which they apply. At the close of the HELP program (March 31, 2024), employees hired under the HELP Program will have their non-competitive employment status converted to competitive status. Employees will then be afforded with all the same rights and privileges of competitive class employees of New York State.
Benefits of Working for NYS
Generous benefits package, worth 65% of salary, including:
Holiday & Paid Time Off
• Thirteen (13) paid holidays annually
• Up to thirteen (13) days of paid vacation leave annually
• Up to five (5) days of paid personal leave annually
• Up to thirteen (13) days of paid sick leave annually for PEF/CSEA
• Up to three (3) days of professional leave annually to participate in professional development
Health Care Benefits
• Eligible employees and dependents can pick from a variety of affordable health insurance programs
• Family dental and vision benefits at no additional cost
Additional Benefits:
• New York State Employees’ Retirement System (ERS) Membership
• NYS Deferred Compensation
• Access to NY 529 and NY ABLE College Savings Programs, as well as U.S. Savings Bonds
• Public Service Loan Forgiveness (PSLF)
• And many more
Some positions may require additional credentials or a background check to verify your identity.
Email Address Jennifer.Sichak@omig.ny.gov
Address
Notes on ApplyingSubmit resume to Jennifer Sichak, Office of the Medicaid Inspector General, 800 North Pearl Street, 2nd floor, Albany, NY 12204, or by email to Jennifer.Sichak@omig.ny.gov with a subject line of “HCSN 4,” or by fax to (518) 408-0395 no later than November 27th, 2023.