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 Apply tot his job Apply To this Job