Review Vacancy
AgencyWorkers' Compensation Board
TitleMedical Care Representative, WCB Item #1431
Occupational CategoryHealth Care, Human/Social Services
Bargaining UnitPS&T - Professional, Scientific, and Technical (PEF)
Salary RangeFrom $59671 to $75785 Annually
Appointment Type Contingent Permanent
Minimum Qualifications Candidates must be reachable on the appropriate Civil Service list, or;
Only permanent Medical Care Representatives are eligible to transfer.
Duties Description Under the Guidance of the Medical Director and SG-25 Principal Medical Care Representative (PMCR) with direct supervision by the SG-23 Supervising Medical Care Representative (SMCR) who oversees the WCB formulary and Impairment Guidelines unit, the SG-19 Medical Care Representative (MCR) will be primarily responsible for the following:
• Perform an in-depth review of all medications denied by the payer and submitted to the WCB appealing the denial by the appropriate party. The MCR will review the medical history of the injured worker in the electronic case file as well as the documentation submitted by the requesting provider in support and justification of the request to vary from the formulary.
• All appeal requests for narcotics will be considered high priority and will be reviewed and decision filed within the required time period.
• Identify non preferred medications that appear to be requested at an increased frequency for consideration of adding them to the formulary. This would include medications that were newly approved by the FDA. The MCR will bring this to the attention of the SMCR who oversees this unit.
• Respond to email and phone inquiries from all internal and external parties including Judges, conciliators, claimants, attorneys, payers and providers requesting assistance with the Impairment Guidelines.
• Review medications requests against diagnoses, medication recommendations, FDA approvals and off label medication allowances.
• Interpret medical documentation including imaging and electrodiagnostic test reports as objective studies for the correct diagnosis and treatment application as they relate to prescription medication recommendations.
• Identifies medically inappropriate requests and brings to the attention of the SMCR for further review and action as deemed appropriate including but not limited to consideration for suspension of WCB authorization status and referral to OPMC.
• Evaluates causal relationship and medical necessity of prescription medications.
• Evaluates and monitors medication prescription trends among providers as a means of tracking opioid dosage and frequency prescribing patterns.
• Assist all parties with the correct application of the 2018 Impairment Guidelines.
Additional Comments Qualified candidates should send a letter of interest and resume which lists your actual Civil Service title, salary grade and specific verifiable information as to how you meet the minimum qualifications to be eligible to apply for this position. Please send your application to HRM@WCB.ny.gov (email applications are preferred). It is important that you reference the WCB Item#1431 in the subject line of your email to ensure receipt of your application. (Please do not reference the Vacancy ID No.)
Some positions may require additional credentials or a background check to verify your identity.