Medicaid Registered Nurse

Medicaid Registered Nurse

Albany, NY (Hybrid: 50% Onsite / 50% Remote)

Salary Range: $68,000 - $71,116.50

About the Role

The Bureau of Specialized Services for Children (BSSC) within the Division of Program Development and Management (DPDM) is seeking a dedicated Registered Nurse to support New York State's Medicaid programs serving children and youth with behavioral health, developmental disabilities, medically complex conditions, and foster care needs.

This position combines clinical expertise, policy development, program management, and stakeholder engagement to help ensure children receive appropriate Medicaid-funded services and supports. The ideal candidate is knowledgeable in pediatric healthcare, comfortable interpreting regulations and policies, and passionate about improving outcomes for vulnerable populations.

Key Responsibilities

Clinical Review & Service Authorization

• Conduct Home and Community Based Services (HCBS) authorization reviews for Children's Waiver participants.
• Evaluate clinical information and make recommendations regarding service eligibility and provision.
• Document, monitor, and track assigned cases in accordance with program requirements.
• Participate in fair hearings and provide clinical support as needed.

Program Support & Technical Assistance

• Provide education and technical assistance to providers, participants, families, and community stakeholders.
• Develop expertise in Children's Health Home, Children's Waiver, Children and Family Treatment and Support Services (CFTSS), and Foster Care/29-I programs.
• Assist with program planning, implementation, evaluation, reporting, and quality improvement initiatives.

Policy & Regulatory Development

• Research Medicaid regulations, guidance, and best practices.
• Develop and revise policies, procedures, provider guidance documents, and training materials.
• Draft program communications, announcements, presentations, and educational resources.
• Deliver webinars and training sessions to internal and external audiences.

Process Improvement & Data Management

• Utilize management information systems to support program operations.
• Recommend system enhancements and process improvements to increase efficiency and service effectiveness.
• Analyze current and proposed service delivery models and provide clinical input on program decisions.

Preferred Qualifications

Preference may be given to candidates with experience in:

• Pediatric nursing, home health, or care coordination
• Medicaid policy, programs, and services
• Home and Community Based Services (HCBS)
• Children's behavioral health services
• Developmental disabilities and medically fragile populations
• Foster care and child welfare systems
• Serious Emotional Disturbance (SED) populations
• Substance use and chronic health conditions affecting children and adolescents
• Policy development, healthcare regulations, and provider training

Required Qualifications

• Bachelor's Degree
• Current New York State Registered Professional Nurse (RN) License

Knowledge, Skills & Abilities

• Strong clinical assessment and critical thinking skills
• Excellent communication and interpersonal skills
• Ability to manage multiple priorities and deadlines
• Strong problem-solving and decision-making abilities
• Proficiency with Microsoft Office and other computer applications
• Ability to work collaboratively with diverse stakeholders
• Experience in pediatric nursing is preferred
• Experience with insurance and claims is preferred

Benefits

SSO offers a comprehensive benefits package designed to support your health, well-being, and financial future, including:

• Medical, Dental, and Vision Insurance
• 401(k) with Discretionary Employer Match
• Paid Time Off and Paid Holidays
• Flexible Spending Accounts (FSA)
• Employee Assistance Program (EAP)
• Employee Discounts and Wellness Perks