Medicaid Registered Nurse - Division of Operations and Systems - 2 Openings in Menands, NY at Public Consulting Group

Date Posted: 9/26/2020

Job Snapshot

  • Employee Type:
  • Location:
    Menands, NY
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:

Job Description

Staffing Solutions Organization LLC (SSO), a wholly owned subsidiary of Public Consulting Group, is focused on delighting clients with world-class managed staffing and talent consulting services. SSO is committed to a diverse workforce, which is a reflection of our clients and the people they serve.

Medicaid Registered Nurse - Division of Operations and Systems in Menands, NY (2 Openings)
Items 1159 & 1160

The Office of Health Insurance Programs Bureau of Medical Review is seeking a Registered Nurse (RN) to work in the Private Duty Nursing Prior Approval Unit. The Bureau of Medical Review is responsible for prior approval and post payment review of medical equipment and services, policy development, fraud and abuse monitoring for the New York State Medicaid FFS System. 


Duties Include:

•       Assist with functions related to the Private Duty Nursing Medically Fragile Directory.  Monitor email inquiries from members and their caregivers, providers and other parties and respond appropriately.  Escalate issues, conflicts, participation issues to supervisory staff as necessary.

•       Assist with maintenance and development of forms and instructions related to the Directory.

•       Evaluate, monitor and make recommendations for enhancements to Directory processes and procedures.

•       Performing prior approvals for Private Duty Nursing Services in the Bureau of Medical Review. 

•       Perform other prior approval duties (change requests, increase in hours, DME reviews).


Minimum Qualifications:

  • Bachelor’s degree and must be currently licensed as registered professional nurse in NYS
  • Four years post licensure professional nursing experience, at least two years which must have been acute care in a licensed healthcare facility.  (School nursing or medical office experience does not apply.)

Desired Characteristics:

•       Experience in prior approval or in examination of medical records, documentation, proposed treatment plans for medical necessity. 

•       Experience with national standards for procedure and diagnosis coding is preferred.

•       Nursing supervision experience and home care experience is preferred.


*Employees must follow established work schedules. The usual work schedule is 40 hours per week, Monday through Friday. Normal work hours are 8:00 a.m. to 4:30 p.m. unless otherwise specified by the supervisor, this includes a half hour unpaid lunch break. Total work hours must equal 40 hours per week.
All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, marital status, age, national origin, protected veteran status, or disability.  Staffing Solutions Organization LLC is an e-Verify participant.

Other details

  • Pay Type Salary
  • Travel Required No
  • Required Education Bachelor’s Degree
  • Menands, NY, USA