Legal Nurse/Medical Analyst:Medicaid Fraud Control Unit (6388)

About the position The Office of the New York State Attorney General's (OAG) Medicaid Fraud Control Unit (MFCU) is seeking experienced Registered Nurses to serve as Medical Analysts in its New York City office. Medical Analysts support the unit by working in partnership with its attorneys, auditors, detectives, data analysts, and legal support analysts to conduct complex, long-term healthcare fraud investigations. The Medicaid program provides health coverage to millions of New Yorkers, including low-income persons, children, elderly adults, and people with developmental disabilities. MFCU is the nation's premier law enforcement agency charged with ensuring the financial integrity of New York state's $94 billion Medicaid program by investigating healthcare providers, such as pharmaceutical companies, doctors, hospitals, and nursing homes, who engage in Medicaid billing schemes that cause harm to Medicaid recipients and the loss of millions of dollars to the state of New York. MFCU also works to protect elderly and disabled New Yorkers by investigating reports of abuse and neglect in nursing homes and other residential health care facilities in the state. Possessing both civil and criminal enforcement powers, MFCU uses various state laws to bring civil actions and criminal proceedings, including asset forfeiture actions. Many of the unit's investigations are conducted in coordination with other federal, state, or local government and prosecutorial agencies, and have resulted in large-scale criminal convictions and the recovery of millions of dollars of taxpayer money.

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

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