Staffing Solutions Organization LLC (SSO), a wholly owned subsidiary of Public Consulting Group, is focused on delighting clients with world-class managed staffing and talent consulting services. SSO is committed to a diverse workforce, which is a reflection of our clients and the people they serve.

Registered Nurse – Medical Review in Menands, NY

Item 1161

The Office of Health Insurance Programs, Bureau of Medical Review is seeking a Registered Nurse (RN) to work as a frontline prior approval reviewer for the Out of State (OOS) Approval Unit. This unit is responsible for prior authorization for Fee for Service (FFS) Medicaid members seeking admission to skilled nursing facilities out of state as well as approval for enhanced payment rates for out of state facilities seeking to provide services for NYS Medicaid members that are not available at in-state or Medicaid network providers.

Duties: 

• Reviewing the prior authorization requests for New York Medicaid individuals requiring specialized or custodial care in out of state facilities, including Medicaid eligibility files, provider enrollment files, and documentation provided to make an administrative determination of appropriateness of requested placement.
• Track all placement requests in the Out of State Database.  Reconcile all placements monthly to assure that all out of state members are being tracked by the Department.
• Review requests for continuation of specialized care and custodial services currently being provided to Medicaid recipients in out of state facilities and make determinations regarding the continuation of care at the facility based on level of care and availability of appropriate care within New York State.
• Assists in the facilitation of repatriation of Medicaid members to in-state nursing homes when required. Coordinate efforts with appropriate State agencies.
• Review and make a determination for all requests for enhanced rates for Out of State requests for services not available in New York facilities.
• For short term, out of state inpatient placements, participate in all progress and discharge conferences during the stay. Work with the facility medical staff and other state agencies for a discharge plan when goals are met at the facility. Assist with transportation arrangements and other services if needed.
• Represent the OOS Program at interdepartmental and interdivisional meetings

Compensation for roles at Staffing Solutions Organization LLC (SSO) varies depending on a wide array of factors including, but not limited to, the specific office location, role, skill set, and level of experience. As required by applicable law, SSO provides the following reasonable range of compensation for this role: [compensation range here]. In addition, SSO provides a range of benefits for this role.

Public Consulting Group is an Equal Opportunity Employer dedicated to celebrating diversity and intentionally creating a culture of inclusion. We believe that we work best when our employees feel empowered and accepted, and that starts by honoring each of our unique life experiences. At PCG, all aspects of employment regarding recruitment, hiring, training, promotion, compensation, benefits, transfers, layoffs, return from layoff, company-sponsored training, education, and social and recreational programs are based on merit, business needs, job requirements, and individual qualifications. We do not discriminate on the basis of race, color, religion or belief, national, social, or ethnic origin, sex, gender identity and/or expression, age, physical, mental, or sensory disability, sexual orientation, marital, civil union, or domestic partnership status, past or present military service, citizenship status, family medical history or genetic information, family or parental status, or any other status protected under federal, state, or local law. PCG will not tolerate discrimination or harassment based on any of these characteristics. PCG believes in health, equality, and prosperity for everyone so we can succeed in changing the ways the public sector, including health, education, technology and human services industries, work.