Medical Care Representative
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.
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/CPT* coding.
*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.
How to Apply:Please click the “Apply Now” button to be redirected to the NYS Application for Examination form. The Exam No is 20-540, Exam Title is Medical Care Representative. All candidates MUST complete and submit this form to be eligible for consideration. Completed forms may be mailed to 15 Computer Drive West, Albany, NY 12205, emailed to firstname.lastname@example.org or faxed to 518-437-1618.
Please note the following important instructions included in the exam announcement when completing this application: "It is essential that you describe your education and experience as completely as possible on the NYS-APP Open Competitive Examination Application form. Ambiguity, vagueness, or omissions will not be decided in your favor. Do NOT send resumes. If you need more space, attach additional 8 1/2" x 11" sheets, following the same format used on the application form." For further information regarding this application form, please visit: https://www.cs.ny.gov/examannouncements/announcements/oc-cr/decentralized/20-540.cfm.
Location/Region: Syracuse, NY