MEDICAL SERVICES SPECIALIST 2641
DISTINGUISHING FEATURES OF THE CLASS
An employee in this class completes medical and social assessments to determine the needs of potential home care and/or long-term home health care clients. The employee may authorize specific hours of personal care services and monitor quality of home care services rendered to eligible Medical Assistance clients or assist vulnerable populations in locating the appropriate care. The incumbent is expected to exercise independent initiative and judgment. Work is performed under general supervision and is reviewed by a professional or administrative superior through conferences and reports for conformance to departmental regulations. Does related work as required.
TYPICAL WORK ACTIVITIES
Performs medical case management functions in accordance with established policies and procedures;
Reviews medical reports to determine the nature of medical care requested, its appropriateness, comprehensiveness and continuity;
Recommends special and complex items of medical care and services in conformity with established departmental policies and procedures;
Identifies and compiles information on individuals unable to obtain an appropriate level of care;
May work closely with hospital discharge planners;
Establishes and maintains close contact with physicians and allied professional personnel; informs them of new and revised policies and procedures of the department;
Reviews and makes recommendations for revisions of medical policies and procedures as they relate to home care in accordance with the changing needs of overall medical treatment plans;
Makes on-site visits to providers to insure compliance with departmental policy, state regulations and the law;
May represent the agency at Fair Hearings or Legislative Meetings.
FULL PERFORMANCE KNOWLEDGES, SKILLS, ABILITIES AND PERSONAL CHARACTERISTICS
Thorough knowledge of the policies and procedures involved in medical diagnosis and treatment; thorough knowledge of the medical terminology used by physicians and other medical personnel; good knowledge of local, State, and Federal laws affecting social welfare, medical and health programs; good knowledge of current literature, sources of information and recent developments in the field of medical assistance programs; ability to establish and maintain effective working relationships with physicians and other medical personnel; ability to interpret policies and procedures for physicians, medical personnel and clerical staff; ability to express oneself clearly and concisely, both orally and in writing; physical condition commensurate with the demands of the position.
Graduation from a college with federally-authorized accreditation or registration by New York State with a Bachelor's or Master's Degree in Nursing or other health or human services field, plus two (2) years of experience as a registered professional nurse in home health care and/or the review of home health care services for medical necessity or in the delivery of preventive health care services. Experience must have been gained within the last ten (10) years.
NECESSARY SPECIAL REQUIREMENT
At the time of appointment and during employment in this
title, employees must possess a Registered Nurse's license issued by the State
Employees must also possess and
maintain a valid license to operate a motor vehicle in