April 30, 2022

Clinical Case Review Analyst

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Department: Health Systems Transformation
Location: Albany, NY

About Us:

NYSTEC is a nonprofit technology consulting company, advising agencies, organizations, institutions, and businesses since 1996. We’re independent and vendor-neutral, so we have our clients’ best interests at heart. At NYSTEC, we know that we succeed when individuals and teams flourish personally and professionally, so our benefits and perks support that mindset. Are you ready to contribute to our engaged workforce and to deliver the NYSTEC Experience?

About the Role:

As a clinical case review analyst in the Health Systems Transformation practice, you will collaborate with team members to conceptualize, deliver, and support our clients through today’s ever-changing healthcare landscape. NYSTEC is considered a trusted program advisor, providing subject matter expertise and connecting the dots for our clients. Over the last five years, NYSTEC has consulted on some of the largest Medicaid initiatives and served in various roles across a multitude of New York State healthcare technology systems. Your day-to-day role as a consultant will be providing clinical analysis expertise to evaluate the 1915(c) Children’s Waiver across New York State. This role will be based in our Albany office.

Key Responsibilities

  • Evaluate child’s/youth’s case for compliance to applicable regulations.
  • Clearly communicate evaluation requirements and follow up.
  • Evaluate documentation against applicable regulations.
  • Collect data and documentation to support compliance findings.
  • Use technology to convert hard copy documentation to electronic and submit via secure file transfer.
  • Record and summarize compliance findings for the Children’s Transformation Program.
  • Assist in determining trends in noncompliance.
  • Make appropriate and timely recommendations to project management.
  • Provide educational guidance, training, and procedures for internal and external stakeholders, as applicable.
  • Assist with the ongoing operationalization of the project’s processes and procedures.
  • Build and maintain relationships with stakeholders to provide a high level of customer service.
  • Coordinate, as needed, to schedule on-site visits.
  • May require travel within New York State to complete on-site reviews on an ongoing basis

About You:

Required Qualifications

  • Four years of experience as a registered nurse in a role working with critical care providers, public health providers, or providers that care for children, older adults, persons with traumatic brain injury, persons with emotional disturbances, or persons with developmental disabilities.
  • One year of experience with monitoring compliance or fee-for-service (FFS) Medicaid or managed care billing.
  • Proficiency in Microsoft Excel, Word, Outlook, Visio, PowerPoint, and SharePoint.
  • For this role, travel is required approximately 10% of the time. Work can be completed remotely as needed.

Preferred/Desired Qualifications

  • Extensive knowledge of Home and Community-Based Services (HCBS) Waiver programs, including the 1915(c) NYS Children’s Waiver.
  • Experience working with Child Adolescent Needs and Strengths – NY (CANS-NY), Uniform Assessment System of New York (UAS-NY), Medicaid Health Homes, or equivalent transformational programs.
  • Experience working with the New York State Office of Mental Health (OMH), Office for People with Developmental Disabilities (OPWDD), or Office of Children and Family Services (OCFS).
  • Experience with multiple electronic health record applications.
  • Ability to work with and relate to staff and demonstrate active listening skills.
  • Ability to foster teamwork with all levels of management and staff.
  • Ability to work well independently and within a team.
  • Exceptional customer service relationship techniques, including superior verbal and written communication skills.
  • Excellent accuracy and attention to detail.
  • Experience in meeting deadlines and adhering to strict standards.

Education and Experience

  • A bachelor’s degree in healthcare or public health study and four years of related experience. An equivalent combination of advanced education, training, and experience will be considered; however, a nursing licensure is required.

If you’re an effective communicator who enjoys working in complex and collaborative environments, using your critical thinking and research skills to develop solutions for clients, providing support to customers, and you have the required education, experience, and skills, we want to hear from you.

Employees are required to comply with NYSTEC’s Vaccination Policy and Prevention Plan. Our policy requires proof of vaccination status or agreeing to submit weekly COVID-19 tests via our ADP portal. New York City office employees and travelers are required to submit proof of vaccination or apply for a workplace accommodation request in accordance with NYC Emergency Executive Order No. 98.

It is NYSTEC’s policy to provide equal employment opportunity (EEO) to all individuals, regardless of actual or perceived race, color, creed, religion, sex, or gender (including pregnancy, childbirth, and related medical conditions), gender identity or gender expression (including transgender status), age, national origin, ancestry, citizenship status, physical or mental disability, protected medical condition as defined by applicable state or local law, genetic information, military service and veteran status, sexual orientation, marital status, or any other characteristic protected by local, state, or federal laws and ordinances. NYSTEC is strongly committed to this policy and believes in the concept and spirit of the law.

Applicants must be authorized to work in the United States without the need for visa sponsorship now or in the future.

Learn more about NYSTEC by visiting www.nystec.com.

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