November 3, 2022

Consultant – Clinical Case Review Analyst

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NYSTEC has a job opening for a consultant – clinical case review analyst. Are you ready to contribute to our engaged workforce and to deliver the NYSTEC Experience?

Department: Health Systems Transformation
Location: Albany, NY
Salary: $58,577 – $80,544 per year

About Us

NYSTEC is a nonprofit technology consulting company, advising agencies, organizations, institutions, and businesses since 1996. Our mission is to deliver extraordinary value through independent advisory services by understanding our clients’ needs and responding effectively to enable their success. We are independent and we are vendor neutral. In other words, we have our clients’ best interests at heart.

At NYSTEC, we succeed when our individuals and teams flourish personally and professionally.

About the Consultant – Clinical Case Review Analyst 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. Specifically, your day-to-day role as a NYSTEC 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: Clinical Case Review Analyst

Overall, in the role of consultant – clinical case review analyst, you will:

  • Evaluate child’s/youth’s case for compliance to applicable regulations.
    • Clearly communicate evaluation requirements and follow up.
    • Evaluate documentation against applicable regulations.
    • Record and summarize compliance findings for the Children’s Transformation Program.
    • Collect data and documentation to support compliance findings.
    • Assist in determining trends in noncompliance.
    • Use technology to convert hard copy documentation to electronic and submit via secure file transfer.
    • Make appropriate and timely recommendations to project management.
  • Assist with the ongoing operationalization of project 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 to complete on-site reviews on an ongoing basis, by region, within the New York state.

About You

Required Qualifications: Clinical Case Review Analyst

Candidates applying for the role of consultant – clinical case review analyst should have the following knowledge, skills, and/or abilities:

  • A minimum of three years’ experience as a registered nurse (RN) 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: Clinical Case Review Analyst

It would be helpful for candidates applying for the consultant – clinical case review analyst role to have the following knowledge, skills, and/or abilities:

  • Extensive knowledge of home and community based services (HCBS) waiver programs, including the NYS 1915(c) Children’s Waiver.
  • Experience working with Child Adolescent Needs and Strengths (CANS-NY), the Uniform Assessment System for 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 to demonstrate active listening skills.
  • Process oriented and results-driven work strategy.
  • 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 Required: Clinical Case Review Analyst

For the consultant – clinical case review analyst role, candidates should have the following education/experience:

  • A bachelor’s degree in healthcare or public health study.
  • Three years of related experience.
  • Current New York State License as an RN in good standing.

An equivalent combination of advanced education, training, and experience may be considered.

Equal Employment Opportunity (EEO)

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.

Reasonable Accommodations

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please contact Talent_Management-Confidential@nystec.com if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.

Work Authorization

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

Interested in NYSTEC’s culture and values? Find out what it’s like to be a NYSTECer.

Apply Today

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, and providing support to customers, we want to hear from you.

Do work that matters.

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