We are GDIT. The people supporting and securing some of the most complex government, defense, and intelligence projects across the country. We ensure today is safe and tomorrow is smarter. Our work has meaning and impact on the world around us, but also on us, and that’s important.
GDIT is your place. You make it your own by embracing autonomy, seizing opportunity, and being trusted to deliver your best every day.
We think. We act. We deliver. There is no challenge we can’t turn into opportunity. And our work depends on a Registered Nurse joining our team to support New York State Department of Health (NYSDOH) Medicaid Management Information System activities based at the GDIT’s office at Riverview Center in Menands, NY.
At GDIT, people are our differentiator. As a Registered Nurse supporting the Provider Services department, you will be trusted to support Utilization Threshold (UT) post-payment reviews. In this role, a typical day will include:
Review of information from the UT edit report (claims that exceed service limits) based on established program policy guidelines
Identify trends for ordering/billing provider patterns that are inconsistent or higher when compared to their peers in the reporting period
Identifying trends for members that are inconsistent or higher than average when compared to peers in the reporting period
Identifying members with diagnoses codes that would qualify for an exemption.
Communicate improper utilization patterns to Department staff for potential referral to DOH Provider on Review or the OMIG’s Restricted Recipient Program
Identify trends that are reviewed in conjunction with provider and member history to determine utilization patterns.
Maintain permanent member exemption list
Update Override Limits in eMedNY when instructed by DOH
Subject matter expertise in NY Medicaid billing functions.
Attend collaborative meetings as required.
Bachelor’s degree and 2+ years’ of nursing or healthcare experience
Active New York State RN License
New York State Medicaid claims knowledge (preferred)
Strong analytical skills
Advanced knowledge of MS Excel
Proficiency in MS office desktop tools
Strong professional communication (oral & written) skills, interpersonal and organization skills.
Strong work ethic and flexibility.
About Our Work
We are GDIT. The people supporting some of the most complex government, defense, and intelligence projects across the country. We deliver. Bringing the expertise needed to understand and advance critical missions. We transform. Shifting the ways clients invest in, integrate, and innovate technology solutions. We ensure today is safe and tomorrow is smarter. We are there. On the ground, beside our clients, in the lab, and everywhere in between. Offering the technology transformations, strategy, and mission services needed to get the job done.
GDIT does not have a vaccination mandate applicable to all employees. To protect the health and safety of its employees and to comply with customer requirements, however, GDIT may require employees in certain positions to be fully vaccinated against COVID-19. Vaccination requirements will depend on the status of the federal contractor mandate and customer site requirements.
GDIT is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status, or any other protected class.