Legal Nurse/Medical Analyst:Medicaid Fraud Control Unit (6388)
About the position Responsibilities • Assisting with screening and evaluating complaints of abuse and neglect for initial follow-up, identifying aberrant diagnoses and treatments, and aiding staff in understanding medical terminology and billing codes. • Identifying and reviewing medical records and analyzing medical documentation to identify potential fraud, abuse, mistreatment and neglect, including testifying as to such analyses in grand jury proceedings and trials. • Assisting detectives in field interviews of medical personnel and experts. • Aiding attorneys in recruiting and preparing health care witnesses (pharmacists, nurses, aides, administrators, physicians, dentists, etc.) for legal proceedings, including grand jury or trial. • Supporting attorneys in preparing for legal proceedings and reviewing legal documents for proper medical terminology. • Monitoring the development and revision of professional standards within nursing and other medical fields of relevance to the unit's mission and advising attorneys and others on such developments and revisions. • Interacting with professional boards and regulatory groups as directed by attorneys in furtherance of the unit's mission. Requirements • A current New York State Registered Professional Nurse's license. • A minimum of seven (7) years of clinical experience. • Knowledge of the current standards and scope of practice for the profession of nursing, as well as knowledge of the general scope and responsibilities of nursing home staff and consultants. • Excellent interpersonal, communication, teamwork, analytical, and writing skills, including the ability to function as an integral part of an investigative team and work in a group setting. • Technology proficiency that preferably includes a knowledge of and experience using Microsoft Office applications such as Outlook, Word, and Excel, and comfort with videoconferencing. Nice-to-haves • Nursing administration (e.g., Director of Nursing, Administrator, Risk Manager, In-Service Coordinator), including current or past employment within a long-term care facility. • Conducting investigations related to resident abuse, mistreatment, or neglect, as well as quality assurance issues. • Case management, MDS 3.0 Resident Assessment, and/or managed care. • Prior experience as a legal nurse consultant. • Knowledge of state and federal rules and regulations related to health care, particularly the Medicaid program. Benefits • Comprehensive New York state benefits package, including paid leave, health, dental, vision, and retirement benefits. • Family-friendly policies. • Robust Workplace Flexibilities Program with multiple options for employees, including telecommuting (up to two days per week) and alternative work schedules. Apply tot his job Apply To this Job