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Registered Nurse
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- The location is responsible for administering New York's Medicaid budget by collaborating with stakeholders across the health care industry including other state agencies, local and federal government agencies, providers, members, and community-based organizations.
- The Division is responsible for the prior approval and pended claims functions for durable medical equipment, private duty nursing, hearing aids, vision care, and dental.
- The Nurse Reviewer will be assigned to the Medical Prior Approval Unit, responsible for review of prior authorization and prior approval of private duty nursing services, durable medical equipment, prosthetics, orthotics, medical supplies, and hearing aids.
- The staff person will perform prior approval review functions to determine if services requested are medically necessary, fall within the scope of coverage of the Medicaid program, and if the service is appropriate for the member's medical needs.
- The position involves utilizing national standards for procedure and diagnosis coding, reviewing appropriate combinations of medical services, and identifying methods to prevent fraud and abuse.
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