M

MedReview

Physician-led payment integrity and audits

Licensed Master Social Worker

Regulatory Compliance & EthicsConfirmed live in the last 24 hours
Full-timeNew York, NY, USA

About the Job

Requirements

  • A Master's Degree in Social Work is required.
  • A current New York State LMSW or LCSW license in good standing is required.
  • Experience in home care, healthcare operations, regulatory compliance, or a related healthcare setting is required.
  • Strong written and verbal communication skills are required.
  • Excellent organizational, analytical, and critical thinking abilities are required.
  • The ability to interpret and apply healthcare regulations and compliance standards is required.
  • Proficiency with Microsoft Office Suite, including Word and Excel, is required.
  • The ability and willingness to travel extensively throughout New York City and other assigned regions as needed is required.

Responsibilities

  • Review and evaluate policy and procedure manuals for compliance with Article 36 and New York State Department of Health regulations.
  • Identify deficiencies and communicate required revisions to applicants and agencies.
  • Review application materials and supporting documentation for licensure and certification requirements.
  • Make recommendations regarding licensure approval, denial, withdrawal, or corrective action based on regulatory findings.
  • Conduct follow-up activities to ensure timely submission of required materials and corrections.
  • Coordinate and participate in pre-opening reviews, conference calls, documentation assessments, and on-site surveys.
  • Evaluate agency readiness, including personnel files, operational processes, environmental space, equipment, and policy implementation.
  • Assess staff knowledge of agency policies and regulatory requirements.
  • Prepare licensure recommendations and related correspondence for agencies and regulatory authorities.
  • Conduct on-site operational surveys of Licensed Home Care Services Agencies.
  • Review client records, personnel files, quality improvement documentation, governing authority meeting minutes, complaint logs, admission materials, and other required records.
  • Identify regulatory deficiencies and prepare Statements of Deficiency (SODs) using state-approved systems and reporting tools.
  • Document findings accurately and ensure all survey activities meet established regulatory standards.
  • Prepare detailed reports, findings, recommendations, and regulatory correspondence.
  • Maintain accurate documentation and tracking of survey activities, corrective actions, and agency communications.
  • Review survey assessment reports and collaborate with leadership on regulatory questions and concerns.
  • Monitor deadlines and maintain organized records of assigned projects and surveys.
  • Partner with internal reviewers, leadership, and regulatory stakeholders to support survey and compliance objectives.
  • Contribute to continuous improvement initiatives and process enhancements.
  • Participate in special projects and additional responsibilities as assigned.

Desired Qualifications

  • Two or more years of social work experience.
  • Experience conducting audits, surveys, compliance reviews, or quality improvement activities.
  • Familiarity with New York State Department of Health regulations and Article 36 requirements.
  • Experience working with Licensed Home Care Services Agencies (LHCSAs).
  • Experience preparing regulatory findings, corrective action plans, or compliance-related reports.

About the Company

MedReview

Physician-led payment integrity and audits

MedReview is a physician-led payment integrity company that reviews and documents every claim it reassigns to ensure accuracy and fairness in billing. Doctors perform clinical reviews across pre- and post-pay audits, resulting in high savings per review and a low rate of appeal overturns. The company uses advanced algorithms blended with machine learning and extensive clinical and claims data to target claims most likely to be inaccurate or abusive. Its services span payment integrity, utilization management, and quality assurance, all aimed at reducing improper payments and saving clients money. Overall, MedReview’s goal is to ensure charges accurately reflect the care provided while helping clients cut unnecessary costs.

Company size
201-500
Company stage
Not listed
Total funding
Not listed
Headquarters
New York City, New York
Founded
1974

Recently Posted Jobs

Explore more opportunities at MedReview

See more jobs