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Medical Care Representative

Company: State of New York
Location: Buffalo
Posted on: January 13, 2022

Job Description:

Minimum Qualifications Reachable on current open-competitive Civil Service list for this title or one year of permanent, competitive class service as a Medical Care Representative.

As this title is filled by Continuous Recruitment examination, you must complete a NYS-application form to apply for list eligibility. Please visit the Department of Civil Service website for more information on how to apply here: https://www.cs.ny.gov/examannouncements/announcements/oc-cr/decentralized/20-540.cfm

Open-competitive List Minimum Qualifications: On or before the date of filing your application, you must have a current license, and be registered to practice as a registered professional nurse in New York State. In addition, you must have had three years of registered nursing experience in the following areas: rehabilitation, medical/surgical, public health, community health, visiting nursing, occupational health, utilization review, or review of medical records from hospitals for appropriate ICD9 or 10/DRG/PAS/CPT* coding.

* International Classification of Diseases - 9th or 10th Volume/Diagnostic Related Groups/Products of Ambulatory Surgery/Current Procedural Terminology.

Substitution: A Nurse Practitioner License in any of the areas listed above, or certification as a certified coder, may be substituted for one year of the qualifying experience.

Duties Description Medical Care Representatives (MCRs) at the New York State Insurance Fund coordinate global case management of high-cost complex cases and are an extensive resource/mentor of the NYS Workers' Compensation Board Medical Treatment Guidelines for Claims Service Managers and other Claims staff. The incumbent will be extensively involved in assessing and monitoring opioid usage as well as instrumental in the preparation for litigation in chronic pain management and other medically-related issues. Duties will include, but are not limited to: Manage daily medication prior authorizations through our Pharmacy Billing Manager intermediary and perform weekly audits on medication usage. Provide in-patient and out-patient, home care, long-term care management of the injured worker. Perform Utilization Review of DME, DRG, EAPG and complex bills and payments. Communicate with medical providers and vendors regarding medical aspects of claims. Utilize multiple complex computer programs and documentation to complete duties as necessary. The ideal candidate should have excellent time management and teamwork skills, as well as the ability to work independently.

Additional Comments Candidates who are not current state employees are encouraged to apply by completing the NYS application form and submitting via email to hr@nysif.com or mail to the attention of the Personnel Office at:


PO Box 66699

Albany, NY 12206

The New York State application form can be found here:


Keywords: State of New York, Buffalo , Medical Care Representative, Healthcare , Buffalo, New York

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