Occ. Code 6464100

 

 

HEALTH SYSTEMS SPECIALIST 1, GRADE 18

6464100

HEALTH SYSTEMS SPECIALIST 1 (FUNERAL DIRECTING), GRADE 18

6464110

HEALTH SYSTEMS SPECIALIST 2 (SOCIAL WORK), GRADE 20

6464210

HEALTH SYSTEMS SPECIALIST 2 (NUTRITION), GRADE 20

6464220

HEALTH SYSTEMS SPECIALIST 2 (PHYSICAL THERAPY), GRADE 20

6464230

HEALTH SYSTEMS SPECIALIST 3, GRADE 23

6464300

HEALTH SYSTEMS SPECIALIST 4, GRADE 25

6464400

 

 

New York State Department of Civil Service

 

Classification Standard

 

BRIEF DESCRIPTION OF CLASS SERIES

 

Positions in this title series develop and administer surveillance and health regulatory programs to ensure services provided meet professional standards of practice, appropriateness, and quality and comply with State, federal, and local statutes and regulations, and the Life Safety Code.  Incumbents of these positions work on teams and/or units involved with Statewide surveillance, medical or programmatic review, audit, and/or regulatory activities to observe and evaluate patient or resident care; investigate and make recommendations regarding licensure or certification; monitor corrective measures and levy enforcement actions; and develop, review, recommend, and implement health policies and procedures.  Incumbents also respond to health emergencies and may be required to pass the Federal Surveyor Minimum Qualifications Test (SMQT) or obtain similar certification examination to retain their positions.

 

These positions are classified at the Department of Health (DOH) in the Central Office Bureaus and Regional Office surveillance and regulatory programs of the Office of Health Systems Management, Office of Long Term Care, and Office of Health Insurance Programs.  It is possible that positions may also be classified at the Office of the Medicaid Inspector General.

 

DISTINGUISHING CHARACTERISTICS

 

HEALTH SYSTEMS SPECIALIST 1: performance level; under general supervision of a higher level Health Systems Specialist or other equivalent supervisory title, independently or as a member of a team (i.e., a multi-disciplinary survey team, medical review or audit team, or Central or Regional Office regulatory program team), perform program surveillance, medical or program review, audit, and regulatory activities.

 

HEALTH SYSTEMS SPECIALIST 2 (PARENTHETICS ONLY): performance level solely for licensed or registered health professionals such as physical therapists, nutritionists, and social workers; under general supervision of a higher level Health Systems Specialist or other equivalent supervisory title, independently or as a member of a team (i.e., a multi-disciplinary survey team, medical review or audit team, or Central or Regional Office regulatory program team), perform health surveillance, medical or programmatic review, audit, and regulatory activities.  There is no generic title.

 

HEALTH SYSTEMS SPECIALIST 3: first supervisory level and/or advanced performance level; under the general supervision of a Health Systems Specialist 4, an Area Office Director, M-3, or an equivalent administrative manager, supervise one or more teams comprised of Health Systems Specialists 1 and 2 and other health program surveillance and regulatory staff, medical review and audit staff, or staff in a Central or Regional Office regulatory program, in the performance of program surveillance, medical or programmatic review, audit, and regulatory activities.

 

HEALTH SYSTEMS SPECIALIST 4: second supervisory level; under the general supervision of an Area Office Director, M-3, or equivalent administrative manager, supervises multiple survey, medical review, or audit teams; may directly supervise surveys of the largest, most complex health facilities, or highly sensitive investigations; or supervises and coordinates the activities of a Central or Regional Office regulatory program unit, in the performance of program surveillance, medical or programmatic review, audit, and regulatory activities.

 

ILLUSTRATIVE DUTIES

 

HEALTH SYSTEMS SPECIALIST 1

 

Participate in surveillance of health care program or residential program with health care services, medical review, audit, and/or regulatory related activities.

 

-          Conduct and/or facilitate on-site surveys independently or part of a team by observing and evaluating patient/resident care against established standards; interviewing staff and reviewing records; investigating incidents and/or patient/resident complaints; and investigating and gathering information on unlicensed heath care facility operations.

 

-          Evaluate records and billings against applicable laws and regulations; identify fraud; and conduct utilization reviews and audits for medical necessity.

 

-          Make recommendations regarding licensure or certification; surveillance, review, and audit findings; recommend corrective measures; and sanctions or enforcement actions.

 

-          Draft and/or review Statements or Notices of Deficiencies, Plans of Correction, investigative reports, and survey information against Statewide standards for consistency and quality assurance.

 

-          Provide staff support and gather data needed to recommend enforcement or sanctions regarding facility and provider licensing decisions.

 

-          Clarify survey protocols for health care providers and evaluate facility applications for the provision of services.

 

HEALTH SYSTEMS SPECIALIST 2 (PARENTHETICS ONLY)

 

Perform all of the same duties and functions as a Health Systems Specialist 1.

 

Serve as a specialist and/or clinical expert based upon advanced licensure or registration.

 

-          Provide training and oversight to team members or unit staff.

 

-          Provide technical assistance to providers and may conduct provider training.

 

-          Develop State policy and clinical and programmatic guidelines for the assigned specialty area.

 

-          Make recommendations on enforcement/sanction actions against regulated or approved providers.

 

-          Develop and implement procedures and reporting systems for utilization review.

 

HEALTH SYSTEMS SPECIALIST 3

 

Perform all of the same duties and functions as a Health Systems Specialist 1 and 2.

 

Supervise and administer, as a team leader, one or more medical review, survey, audit, and/or investigative teams that perform either all and/or components of Statewide and/or regional health care program or residential program with health care services surveillance, medical review, audit, and/or regulatory related activities.

 

-          Responsible for oversight of regional or Statewide quality assurance activities related to surveillance, medical review, survey processes, and/or medical assistance programs, including but not limited to: coordination of preparation activities; on-site actions; analysis of data and information; entrance and exit interviews and conferences; and summary of findings and actions.

 

-          Determine staff work assignments and priorities; review, monitor, and evaluate staff and work products; approve leave, track time and attendance, and participate in performance evaluations; and train staff, including staff from other agencies and non-State staff.

 

-          Collect and analyze survey data and patterns of deficiencies to identify patterns of non-compliance and evaluate Statewide consistency in the application of health care related laws, rules, and regulations.

 

-          Finalize and present recommendations regarding licensure or certification; surveillance, review, and audit findings; corrective measures; enforcement actions; and Statements or Notices of Deficiencies, Plans of Correction, investigative reports, and survey information.

 

-          Administer programs that license or certify regulated health providers, including but not limited to: evaluating applications, developing and implementing educational standards and continuing education programs, and working with various jurisdictions.

 

-     Interact with government officials, health industry providers, and administrators to communicate survey and investigation findings; negotiate plans of correction, settlements, and other provider appeals; and provide technical assistance to providers.

 

-          Serve as a liaison and expert representing the Department at administrative hearings, proceedings, and meetings.

 

-          Analyze Informal Dispute Resolution documents submitted by facilities against information in survey reports and make recommendations for resolving disputes.

 

Develop, review, recommend, and implement Statewide health care program surveillance, medical review, audit, and regulatory policies and procedures.

 

-          Plan, develop, and recommend regional or Statewide health service delivery system policies and procedures, taking into account State, federal and local laws, regulations, and program operations.

 

-          Coordinate enforcement activities in regard to health facility violations resulting from surveys, medical reviews, audits, and/or investigations.

 

-          Manage regulatory-related grants and contracts for services and develop related policies and procedures.

 

-          Administer programs that train, license, and/or certify individual health or other regulated providers including nursing home administrators, home health and personal care aides, nurse aides, and funeral directors.

 

-          Conduct health workforce planning and monitoring.

 

Review facility emergency plans for adequacy and compliance, and advise and respond when appropriate.

 

If working in a non-supervisory (advanced performance level) function in Central Office:

 

-        Review survey and compliance investigation reports and facility plans of correction to ensure that deficiencies are appropriately documented and meet federal and State requirements.

 

-        Monitor regional survey schedules, survey processes, and outcomes to ensure that surveys are completed in a timely manner.

 

-        Monitor and evaluate regional survey data to ensure Statewide and regional consistency in the application and enforcement of laws, regulations, and other requirements.

 

-        Analyze survey data to identify patterns of non-compliance and make recommendations for regulatory or policy changes or provider training to improve compliance and the quality of health care.

 

-        Conduct Central Office review and recommendation on regional cases that meet criteria for movement to enforcement proceedings.

 

-        Assist in the development of Statewide policies, and make recommendations for new or revised State regulations, policies, and procedures.

 

-        Develop and/or evaluate survey or medical review protocols and procedures to implement new regulatory requirements, address identified program needs, or implement new program initiatives.

 

-        Work cooperatively with Central and Regional Office managers to identify staff development needs, develop training curriculum, and administer training programs.

 

-        Mentor and train new professional staff.

 

-        Participate in the development and implementation of workforce succession plans.

 

If working in a non-supervisory (advanced performance level) function in Regional Offices:

 

-        Administer a component of a Regional Office program in such areas as follows:

 

·        Ensure that federal and State laws and regulations are applied and enforced in a consistent and appropriate manner.

 

·        Schedule surveys and/or complaint investigations to meet federal, State, and Department requirements.

 

·        Monitor contracts with providers.

 

·        Serve as a liaison between Regional Office programs or between the Regional and Central Office programs.

 

·        Develop Regional Office program procedures to ensure adherence to Department policies.

 

·        Review survey reports to ensure that deficiencies are appropriately documented.

 

·        Provide guidance to survey staff.

 

·        Conduct follow-up site visits for quality assurance purposes.

 

·        Review applications for new or expanded services and make recommendations for licensure/certification/approval.

 

-        Conduct investigations of more complex and sensitive complaints including interviewing facility staff, executives, patients and family members, preparing reports on findings, and reviewing plans of correction.


 

-        Manage various Regional Office programs, such as:  the hospital complaint investigation program in a small office; the EMS program for a geographic area; or acting as an Assistant Director of a small regional surveillance program.

 

HEALTH SYSTEMS SPECIALIST 4

 

Perform all of the same duties and functions as a Health Systems Specialist 1, 2, and 3.

 

Supervise multiple medical review, survey, audit, and/or investigative teams or large teams that perform either all and/or components of Statewide and/or regional health care surveillance, medical or programmatic review, audit, and/or regulatory related activities.

 

Make decisions or issue recommendations in areas where regulation, policy, and surveillance guidelines are not clear.

 

Direct and/or approve enforcement actions that result from medical reviews, surveys, audits, and/or investigations.

 

Develop, coordinate, and implement plans to respond to unexpected events that may include labor strikes, facility closures, natural disasters, pandemics, terrorist attacks, etc.

 

MINIMUM QUALIFICATIONS

 

HEALTH SYSTEMS SPECIALIST 1

 

Open Competitive: Bachelors Degree and two years of professional administrative or professional clinical experience in one or more of the following areas:

 

·        Program administrative experience in a health care facility regulated by a governmental agency.

 

·        Responsibility for regulatory compliance and/or quality assurance activities in a health care delivery system.

 

·        Participating in the development or implementation of State or federal regulations that govern the provision of health care.

 

·        Clinical supervision of staff that provide health related services in a facility regulated by a governmental agency.

 

·        Evaluating the quality of care provided to individuals to ensure that professional standards of practice are met and services comply with governmental regulations.

 

A Masters Degree in health care administration, hospital administration, or health care finance may substitute for one year of experience.  General administrative experience in personnel, budgeting, purchasing, security, or maintenance is not qualifying.  Experience in a physicians office or school setting is not considered qualifying.

 

           

HEALTH SYSTEMS SPECIALIST 1 (FUNERAL DIRECTING)

 

Open Competitive:  Bachelor's Degree, current New York State licensure as a Funeral Director, and two years of administrative experience in a health/human services organization.

 

HEALTH SYSTEMS SPECIALIST 2 (SOCIAL WORK)

 

Open Competitive:  Current licensure as either a Licensed Master Social Worker or Licensed Clinical Social Worker with the New York State Education Department and two years of post-Masters experience:  providing clinical services in a licensed health facility/program OR utilizing clinical knowledge in the review or oversight of clinical services for quality assurance or reimbursement purposes.

 

            HEALTH SYSTEMS SPECIALIST 2 (NUTRITION)

 

Open Competitive:  Current registration with the Commission on Dietetic Registration and two years of experience:  providing clinical services in a licensed health facility and/or program which includes hospitals, nursing homes, adult homes, ambulatory care facilities, managed care organizations, psychiatric centers, developmental centers, diagnostic and treatment centers, and home health care agencies  OR utilizing clinical knowledge in the review or oversight of clinical services for reimbursement or quality assurance purposes.

 

            HEALTH SYSTEMS SPECIALIST 2 (PHYSICAL THERAPY)

 

Open Competitive:   Current licensure and registration with the New York State Education Department to practice as a physical therapist and two years of experience:  providing clinical services in a licensed health care facility and/or program which includes hospitals, nursing homes, adult homes, ambulatory care facilities, managed care organizations, psychiatric centers, developmental centers, diagnostic and treatment centers, and home health care agencies OR utilizing clinical knowledge in the review or oversight of clinical services for reimbursement or quality assurance purposes.

 

HEALTH SYSTEMS SPECIALIST 3

 

Promotion: one year of permanent competitive service as a Health Systems Specialist 1, or Health Systems Specialist 2; or as a Medical Care Administrator; Fire and Safety Representative; Specialist in Adult Services 1; Senior Emergency Medical Care Representative; Senior Nutritionist; Senior Sanitarian; Supervising Funeral Directing Investigator; Standards Compliance Analyst 1; Health Care Surveyor 2 (Nursing); Senior Public Health Social Work Consultant; Consultant Physical Therapist; Nutrition Services Consultant; Community Nursing Services Consultant; Hospital Nursing Services Consultant; Regional Medical Care Administrator; Senior Nutrition Services Consultant; and Senior Public Health Social Work Consultant.

 

HEALTH SYSTEMS SPECIALIST 4

 

Promotion:  one year of permanent competitive service as a Health Systems Specialist 3; OR Community Nursing Services Consultant; Hospital Nursing Services Consultant; Regional Medical Care Administrator; Senior Nutrition Services Consultant; Senior Public Health Social Work Consultant; Principal Sanitarian; Specialist in Adult Services 2; Standards Compliance Analyst 2; and Consultant Nurse.

 

 

Date:  5/09

 

 

NOTE: Classification Standards illustrate the nature, extent and scope of duties and responsibilities of the classes they describe.  Standards cannot and do not include all of the work that might be appropriately performed by a class.  The minimum qualifications above are those which were required for appointment at the time the Classification Standard was written.  Please contact the Division of Staffing Services for current information on minimum qualification requirements for appointment or examination.