Review Vacancy
AgencyWorkers' Compensation Board
TitleMedical Care Representative, WCB Item #3721, 3723, 3725, 3727
Occupational CategoryHealth Care, Human/Social Services
Bargaining UnitPS&T - Professional, Scientific, and Technical (PEF)
Salary RangeFrom $59671 to $75785 Annually
Minimum Qualifications Candidates must be reachable on the appropriate Civil Service list,
- OR -
Only permanent Medical Care Representatives are eligible to transfer.
Duties Description Under the direct supervision of the Supervising Medical Care Representative the Medical Care Representative duties include, but are not limited to:
• Conduct medical necessity reviews of Prior Authorization Requests for treatment/procedures and/or testing to determine the medical necessity of treatments requested for injured workers in accordance with evidence based Medical Treatment Guidelines to determine if the request meets the criteria for approval.
• Conduct medical necessity reviews of Drug Formulary Prior Authorization requests in accordance with Part 441 of 12 NYCRR.
• Conduct medical necessity reviews of Durable Medical Equipment Prior Authorization requests in accordance with Section 442.2 of Title 12 NYCRR.
• Conduct medical necessity reviews of Prior Authorization Requests of medical care of services requests (Special Services), in accordance with Regulation 324.2(d)(2) of Title 12 NYCRR of the Workers’ Compensation Law and the Board’s Medical Treatment Guidelines.
• Issue Notices of Resolution for each assigned Prior Authorization Request.
• Handle phone calls transferred from HSCC and emails submitted to various MDO mailboxes from providers, carriers, attorneys and injured workers requesting assistance and interpretation of the Special Services.
Additional Comments Please note: These positions are being posted in anticipation of approved waivers.
These positions may be designated 55 b/c and are subject to verification of applicant eligibility.
Some positions may require additional credentials or a background check to verify your identity.
Address
Street Human Resources Management- Room 133
328 State Street
Notes on ApplyingQualified candidates should send a letter of interest and resume which lists your actual Civil Service title, salary grade and specific verifiable information as to how you meet the minimum qualifications to be eligible to apply for this position. Please send your application to HRM@WCB.ny.gov (email applications are preferred). It is important that you reference the WCB Item #3721 in the subject line of your email to ensure receipt of your application. (Please do not reference the Vacancy ID No.)