City Of New York

COMPLEX MEDICAL CASE REVIEWER

City Of New York$80K — $95K *
Healthcare
Less than 5 years of experience
Job Overview by Ladders

Qualifications

  • Valid New York State License and current registration as a Registered Professional Nurse.
  • Three years of full-time experience as a Registered Nurse, including two years in a supervisory role.
  • Experience required can be in a hospital or appropriate healthcare setting.
  • For more advanced roles, a Psychiatric Nurse Practitioner program completion or current certification is needed.
  • Experience as a Psychiatric Nurse Practitioner counts as supervisory experience.

Responsibilities

  • Conduct medical reviews and analyze claims for calculating Medicaid liens.
  • Consult various records and documents to support lien calculations.
  • Update database systems with relevant notes and records.
  • Draft correspondence related to aid paid and lien agreements.
  • Negotiate Medicaid lien repayments with plaintiff's counsel.
  • Submit affidavits to court and testify to support lien calculations.

Benefits

  • Regular working hours from 9AM to 5PM.
  • Potential for professional growth in complex medical reviews.
  • Collaboration with legal professionals and exposure to court processes.
Full Job Description
Office of Liens and Trusts (OLT) is recruiting for (1) one Supervisor of Nurses I to function as a Complex Medical Case Reviewer, who will: -Conduct medical reviews and analyses claims to calculate injury related Medicaid liens pursuant to SSL-104b on cases involving medical malpractice, mass medical torts, lead paint poisoning, traumatic brain injury, or other catastrophic or medically complex cases. -Consult Medicaid payment records, bills of particulars, and other legal or medical documents provided. Update database system with notes and other records to support calculations. -Draft appropriate correspondence including statements of aid paid, notice of lien letter, affidavits and lien agreement letters. Fax and/or mail correspondence to plaintiff attorneys, defense attorneys, and/or clients. When appropriate submit affidavit to court supporting lien calculations and conclusions. -Communicate with plaintiff's counsel to obtain additional medical documentation or information. Negotiate repayment of the Medicaid lien with counsel. -Testify in Court to defend and support the Department of Social Services' lien. Hours/Shift: 9AM -5PM SUPERVISOR OF NURSES - 50960 Qualifications A valid New York State License and current registration to practice as a Registered Professional Nurse. This license must be maintained for the duration of employment. AND: For Assignment Level I In addition to meeting the license requirement above, candidates must have three years of full-time satisfactory experience as a Registered Nurse, two of which must have been in a supervisory capacity within a hospital or other appropriate setting. For Assignment Level II In addition to meeting the license requirement above, candidates must: a) have completed a Psychiatric Nurse Practitioner or equivalent program registered or approved by the New York State Education Department; or b) have current certification as a Psychiatric Nurse Practitioner by a national certifying body recognized by the New York State Education Department. In addition, candidates must have three years of full-time satisfactory experience as a Registered Nurse, one of which must have been working in the capacity of Psychiatric Nurse Practitioner. Additional Information

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