Complex Medical Case Reviewer

City of New York • New York, NY

6d

About The Position

The Department of Social Services (DSS) is comprised of the administrative units of the New York City Human Resources Administration (HRA) and the Department of Homeless Services (DHS). HRA is dedicated to fighting poverty and income inequality by providing New Yorkers in need with essential benefits such as Food Assistance and Emergency Rental Assistance. DHS is committed to preventing and addressing homelessness in New York City by employing a variety of innovative strategies to help families and individuals successfully exit shelter and return to self-sufficiency as quickly as possible. The DSS Accountability Office (DSS-AO) is responsible for protecting the integrity of social services programs administered by the New York City Department of Social Services (DSS) and ensuring that DSS complies with all statutory, regulatory, and contractual standards. The Office of Revenue comprises divisions and offices performing revenue collections and centralized data reporting. The Division of Liens and Recovery Casualty Program places liens and assert claims against the personal injury lawsuit settlements of past or present recipients of Medicaid and Cash Assistance pursuant to NYS SSL 104 and 104-b. At the time of a lawsuit settlement, law firms and insurance companies must contact the Division to obtain a final lien amount. Total settlement amount from all defendants is needed to discuss lien re-payment. 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.

Requirements

• 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.
• 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.

Responsibilities

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 5,001-10,000 employees