Duties Description The Division of Medicaid Investigations (DMI) ensures the integrity of the Medicaid program by conducting investigations, making referrals to other partner agencies and licensing boards when appropriate, recovering overpayments, and implementing administrative sanctions against providers.
Duties of this position include a range of activities, specifically, but not limited to:
• Conducting or participating in investigations or on-site reviews of health care settings to determine their level of compliance with federal and State rules and regulations.
• Participating in the general assessment, planning, development, implementation or review of health care programs.
• Serving as a nursing services expert, testifying as an expert witness, providing clinical support in litigation/administrative hearing proceedings.
• Evaluating patient care/healthcare services to ensure it is in accordance with accepted clinical standards of practice.
• Performing medical record review, reviewing prescribing information and other pertinent documentation.
• Analyzing and reviewing data utilizing clinical knowledge.
• Understanding and applying proper use of healthcare codes (ICD/CPT/HCPCS) to clinical and data reviews.
• Interpreting policies, rules and regulations.
• Representing the department at meetings and public forums.
• Participating in special projects/project teams for the department.
Minimum Qualifications PREFERRED QUALIFICATIONS:
The ideal candidate will have a strong clinical background with knowledge of ICD-10-CM, CPT, and HCPCS Level II codes, and/or possess a Certified Professional Coder (CPC) credential, have experience with interpreting and analyzing data sets, and be comfortable utilizing Microsoft Office Suite products. Excellent verbal and written communication skills and attention to detail are preferred.
MINIMUM QUALIFICATIONS:
Permanent Transfer candidates: Current New York State employee with one year of permanent or contingent-permanent service as a Health Care Surveyor 3 Nursing, SG-22.
Non-Competitive NY HELPS Qualifications:
License and current NYS registration as a Professional Nurse and three years of post-licensure, specialized professional administrative or professional clinical experience.
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.
Substitution: A bachelor's degree in nursing may substitute for one year of post-licensure clinical nursing experience; a master's degree in nursing may substitute for two years of post-licensure clinical nursing experience.
Additional Comments Permanent, non-competitive, full-time. Free parking available. Current licensure and registration to practice as a professional Nurse in New York State is necessary for continued employment as a Health Care Surveyor 3 Nursing. Action will be taken to remove you from your position if you fail to maintain licensure and registration.
This position requires approximately 20% travel. Must have a valid driver's license or otherwise demonstrate the ability to meet the transportation requirements of the position.
*Posted salary range includes statutory hiring rate at Step 4 and job rate for PS&T Grade 22 ($86,031 - $108,921), an additional Geographic Pay Differential of $35,000, and a Downstate Adjustment of $4,150. Starting salary for non-NYS Employees is NON-NEGOTIABLE.
**The Department of Civil Service has developed the New York Hiring for Emergency Limited Placement Statewide Program (NY HELPS), which is a streamlined program that allows appointment to this title and others without examination.
For the duration of the NY HELPS program, this title may 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.
Some positions may require additional credentials or a background check to verify your identity.
Name Jenn S.
Telephone
Fax
Address
Street 800 North Pearl St
2nd Floor
City Albany
State NY
Zip Code 12204
Notes on Applying Submit resume to Jenn S., by email to Recruitment@omig.ny.gov with a subject line of HCSN 3, no later than November 25, 2026.
PLEASE NOTE: We are unable to open documents from Google Docs, Google Drive, OneDrive, Apple Pages, and/or "the cloud". Please submit resume as a Word or PDF attachment.
OMIG does not participate in E-Verify and does not sponsor visa applications.
