State of Maryland

A Medical Services Reviewing Nurse Supervisor is the supervisory level of work reviewing medical assistance or compensation claims to ensure that the medical services provided are of a nature and quality that is consistent with State and federal regulations. These employees also conduct reviews to guard against fraud and abuse.  Employees in this classification supervise lower-level Medical Services Reviewing Nurses and other professional and nonprofessional support staff.

Employees in this classification receive general supervision from a higher-level health administrator.

Positions in this classification are evaluated by using the classification job evaluation methodology.  The use of this method involves comparing the assigned duties and responsibilities of a position to the job criteria found in the Nature of Work and Examples of Work sections of the class specification.

The Medical Services Reviewing Nurse Supervisor is differentiated from the Medical Services Reviewing Nurse II in that the Medical Services Reviewing Nurse Supervisor has supervisory responsibility for lower-level Medical Services Reviewing Nurses, while the Medical Services Reviewing Nurse II performs the full range of duties and responsibilities under general supervision.

Supervises Medical Services Reviewing Nurses and other professional and nonprofessional support staff;

Administers a specific program, such as monitoring the activities of a privately contracted Utilization Control Agent;

Reviews medical assistance claims from physicians and other health care providers to ensure consistency with State and federal regulations and that medical treatment is correct and necessary;

Reviews patient medical histories to determine possible misuse of medical assistance funds;

Investigates complaints from recipients and other agencies to determine the need for corrective action;

Documents all findings and recommendations of reviews and investigations;

Provides information concerning medical assistance regulations to recipients, physicians and other concerned parties;

Recommends that cases be investigated for criminal involvement or that corrective action be taken against recipients;

Testifies as an expert witness during official hearings;

Performs other related duties.

Class Descriptions are broad descriptions covering groups of positions used by various State departments and agencies.  Position descriptions maintained by the using department or agency specifically address the essential job functions of each position.

Class Descriptions provide information about the Nature of Work, Examples of Work, General Requirements and Acknowledgements.  The Required Knowledge, Skills, and Abilities; Minimum Education and Experience Requirements; Special Requirements; and recruitment and testing procedures are set by the using agency.

This is a Professional Service classification in the State Personnel Management System.  All positions in this classification are Professional Service positions.  Some positions in Professional Service classifications may be designated as Special Appointment in accordance with the State Personnel and Pensions Article, Section 6-405, Annotated Code of Maryland.

This classification is not assigned to a bargaining unit, as indicated by the designation of S (Supervisor), M (Manager), T (Agency Head), U (Board or Commission Member), W (Student), X (Used by Agency or Excluded by Executive Order), or Z (Confidential).  As provided by State Personnel and Pensions Article, Section 3-102, special appointment, temporary, contractual, supervisory, managerial and confidential employees are excluded collective bargaining.  Additionally, certain executive branch agencies are exempt from collective bargaining and all positions in those agencies are excluded from collective bargaining.