Healthcare Professional

Minimum Qualifications

Candidates must possess a current license and registration as a registered professional nurse in New York State and two years of registered nursing experience in rehabilitation, medical/surgical, public health, community health, visiting nursing, occupational health, utilization review, or review of medical records from hospitals for appropriate ICD 9 or 10/DRG/PAS/CPT coding.

A bachelor's degree in nursing can substitute for one year of post-licensure clinical nursing experience. A master's degree in nursing can substitute for two years of post-licensure clinical nursing experience.

Duties Description

Reporting to a Registered Nurse supervisor, Registered Nurse 2 positions at NYSIF are responsible for coordinating global case management of high-cost complex cases and serving as an extensive resource/mentor of the NYS Workers' Compensation Board Medical Treatment Guidelines for Claims Service Managers and other Claims staff.

Each Registered Nurse 2 will be assigned to one of the following focused teams: claimant outreach/accelerated care plan catastrophic and/or high-cost claims team, prior authorization team, or claims management and consulting team.

Duties will include, but not be limited to:

• Identify and manage high medical exposure claims for NYSIF.
• Early intervention of medically complex claims to decrease exposure and provide increased customer satisfaction.
• Contact claimants and potentially providers, facilities, families, employers, etc. based on the claimant's medical status.
• Evaluate and authorize or deny prior authorizations for medications and durable medical equipment.
• Serve as a resource to claims staff in providing effective medical knowledge and management of these claims.