Job Description:
Description Duties Description This individual will assist in implementing and evaluating health reform initiatives with a primary focus on quality oversight of Managed Long Term Care (MLTC) plans. These activities will require knowledge of Clinical Nursing documentation standards, applicable State and Federal regulations and a strong understanding of medical records and healthcare protocols. Job duties would include: 1) Conduct desk audits of MLTC plans enrollee records, performing a clinical review to ensure adherence to the model contract, and State and Federal Public Health Law requirements, guidelines and statutes. 2)Perform as a subject matter expert for Surveillance Staff on Managed Long Term Care and Medicaid providing Clinical documentation guidance on compliance determinations. Additionally, the individual will conduct quality reviews on staff’s clinical compliance determinations on record reviews to ensure interrater reliability. 3) Supervise Surveillance Team record reviwer clinical Staff, performing supervisory duties including; hiring, LATS approvals, Probation Reviews and Annual Performance Evaluations and discipline as needed. 4)Prepare reports and written feedback to internal and external stakeholders that include MLTC Plans, local social service districts, State agencies, clients, health care providers, advocacy groups, and professional organizations. 5) Assist Bureau of Managed Long Term Care team with a range of planning, implementation, reporting, training and Medicaid surveillance activities as needed.Qualifications Minimum Qualifications Permanent Transfer Candidates: Current NYS Department of Health employee with one year of permanent or contingent-permanent, competitive service as a Health Care Surveyor 3 (Nursing), G23NY HELPS: Possession of a license and current registration as a registered professional nurse in New York State; and three years of post-licensure, specialized professional administrative or professional clinical experience.Substitution: A bachelor's degree in nursing may substitute for one year of post-licensure clinical nursing experience; and a master's degree in nursing may substitute for two years of post-licensure clinical nursing experience.Preferred Qualifications: Preferred Qualifications: Critical thinking skills, analytical skills with Microsoft Excel, ability to solve problems independently. Current clinical care knowledge. Possession of a license and current registration as a registered professional nurse in New York State; and two years of post-licensure, specialized professional administrative or professional clinical experience. Experience with home health care or other Home and Community Based Services is a plus.Additional CommentsPosted salary range includes the statutory hiring rate at Step 4 and job rate for PS&T Grade 22 ($90,900 - $101,197) and an additional Geographic Pay Differential of $20,000.We offer a work-life balance and a generous benefits package, worth 65% of salary, including: Holiday & Paid Time Off Public Service Loan Forgiveness (PSLF) Pension from New York State Employees’ Retirement System Shift & Geographic pay differentials Affordable Health Care options Family dental and vision benefits at no additional cost NYS Deferred Compensation plan Access to NY 529 and NY ABLE College Savings Programs, and U.S. Savings Bonds And many more...For new State employees appointed to graded positions, the annual salary is the hiring rate (beginning of the Salary Range) of the position. Promotion salaries are calculated by the NYS Office of the State Comptroller in accordance with NYS Civil Service Law, OSC Payroll rules and regulations and negotiated union contracts.The NYS Department of Health is committed to making New York a safer, healthier, and more equitable place to live. Understanding health equity, social determinants of health and health disparities is critical to accomplish our goal of eliminating health disparities. For more information on the NYS Department of Health’s Mission, Vision, Values and Strategic Plan, please visit: