The New York State Office of the Attorney General’s Medicaid Fraud Control Unit (MFCU) is seeking an experienced Registered Nurse to serve as a Medical Analyst for its New York City office.

 

The Medical Analyst supports 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. Utilizing the New York State Penal Law, the False Claims Act, Social Services Law §145-b, the Executive Law, and other New York laws, the Unit brings civil actions and criminal proceedings to successfully prosecute individuals and companies who are responsible for improper or fraudulent Medicaid billing schemes. Many of the Unit’s investigations are conducted in coordination with other state, federal or local government and prosecutorial agencies, and have resulted in revenue generation through the large-scale recovery of taxpayer money. Several matters that highlight MFCU’s important work include the sentencing of a Bronx clinic owner for defrauding New York State out of more than $4 Million in false Medicaid claims; the conviction of a former fugitive dentist for Medicaid fraud; and the extradition, arrest, and arraignment of a Medicaid fraud ringleader.

 

Additionally, MFCU works to safeguard elderly and disabled New Yorkers by investigating reports of abuse and neglect at nursing homes and other residential health care facilities in the state, and also brings civil actions and criminal proceedings to successfully prosecute individuals and companies for neglect and abuse. The importance of this work is highlighted in the OAG’s report investigating allegations of COVID-19-related neglect of nursing home residents across New York State.

·       Assisting with screening and evaluating complaints for initial follow-up, as well as aiding staff in understanding medical terminology and billing codes, and identifying inconsistent diagnoses and treatments;

·       Identifying and reviewing medical records and analyzing medical documentation to identify trends in fraud, abuse, mistreatment and neglect;

·       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 the development of areas of questioning to be used at legal proceedings including grand jury or trial, as well as supporting and testifying in grand jury proceedings and trials;

·       Assisting attorneys in reviewing legal documents for use of 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; and

·       Interacting with professional boards and regulatory groups as directed by attorneys in furtherance of the Unit’s mission.

 

·       A current NYS Registered 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;

·       The ability to function as an integral part of an investigative team and work in a group setting; and

·       Technology proficiency that preferably includes a knowledge of and experience with Microsoft Office applications such as Outlook, Word, and Excel.

·       Nursing administration (i.e. Director of Nursing, Administrator, Risk Manager), 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;

·       Drug diversion investigations;

·       Managed care;

·       Prior experience as a legal nurse consultant; and

·       Knowledge of NYS and federal rules and regulations related to health care, particularly the Medicaid program.

 

The starting salary for this position is $75,914 + $3,026 in location pay. As an employee of the OAG, you will join a team of dedicated individuals who work to serve the people of our State through a wide variety of occupations. We offer a comprehensive New York State benefits package, including paid leave, health, dental, vision and retirement benefits, and family-friendly policies. Additionally, the OAG offers a robust Workplace Flexibilities Program with multiple options for employees, including telecommuting (up to two days per week) and alternative work schedules.

 

Per Office of the Attorney General policy, confirmation of vaccination status is a condition of employment for this position. If you are not fully vaccinated, you may be required to provide regular negative COVID-19 PCR test results at a frequency determined by the agency. The agency will consider religious and reasonable accommodations. For more information, please contact recruitment@ag.ny.gov.

 

Applicants must be prepared to submit a complete application consisting of the following:

·       Cover Letter

-      You may address to Legal Recruitment.

-      Indicate why you are interested in a position with MFCU and what makes you a strong candidate.

·       Resume

·       Writing Sample

·       List of three (3) references

-      Only submit professional references, supervisory references are preferred.

-      Indicate the nature and duration of your relationship to each reference.

-      Include contact information and email addresses for each reference.

-      Please note, your references will not be contacted until after you interview for the position.