Disability Reviewer II

UMass Med School; Westborough (MA); In loco; USD 68.000 - 80.000; Tempo pieno

Descrizione del lavoro

UMass Chan Medical School in Westborough, MA seeks a Disability Reviewer II to lead reviews for state agencies and retirement programs. You will assess medical and vocational evidence to determine eligibility under state and federal laws, and participate in appeals with agencies and applicants.

The role requires nursing or allied health credentials with several years of relevant experience, strong teamwork, and attention to HIPAA. Travel may be required as part of duties.

Competenze

• RN with current unrestricted license and three years of relevant experience.
• Masters prepared licensed or certified vocational rehabilitation counselor or allied health professional with 2 years of relevant experience in medicine, long-term care, mental health, developmental disabilities, substance abuse, rehabilitation and/or vocational counseling.
• Ability to work in a team environment, interpret state and federal laws and regulations, meet performance deadlines in a dynamic environment.
• Excellent oral and written communications skills.
• Demonstrated experience using computer-based tools including electronic mail, word processing and database products.
• Ability to travel off site as needed.

Mansioni

• Lead and perform diverse work for multiple state disability agencies and related entities.
• Review medical/psychiatric evidence, vocational profiles, and regulations to determine eligibility.
• Participate in appeals process for denied claims with state agencies and applicants.
• Efficiently manage a caseload of disability applicants seeking benefits.
• Collaborate with a multidisciplinary team of nurses, counselors, and physician advisors.
• Support quality improvement initiatives and adhere to procedures and HIPAA regulations.
• Maintain confidentiality and positive relationships with stakeholders.
• Document information into data system applications.
• Follow health, safety and program regulations; perform other duties as required.

Formazione

RN license or professional nursing license

Masters prepared vocational rehabilitation counselor or allied health professional

Strumenti

Email

Word processing

Database software

Descrizione del lavoro

Disability Reviewer II

Minimum Salary

• USD $68,000.00/Yr.
• USD $80,000.00/Yr.

Job Location

US-MA-Westborough

Shift

Exempt

Union Code

Non Union Position - Non Unit Professional (W60)

Position Type

Full-Time

Overview

GENERAL SUMMARY OF POSITION:

Under the general direction of the Program Manager or designee, the Disability Reviewer II leads and performs diverse work for multiple State disability determination agencies, Public Retirement Systems and assessments / reviews for the Office of Clinical Affairs and other UMass Chan Medical School (UMass Chan) entities or State agencies. These assessments may include the review of medical evidence, psychiatric evidence, vocational profiles, state statues and guidelines and any other pertinent evidence to determine whether an individual meets the standards in accord with applicable state and federal laws and regulations. The diversity of work carries with it significant responsibilities in that the outcome results in the awarding or denial of benefits to the applicant and/or retiree.

Responsibilities

MAJOR RESPONSIBILITIES:

• Assume responsibility for being an emergent intervention agent when confronted with a client-in-a-crisis situation.
• Contact providers, state agency offices, case managers and clients to obtain information and records needed to conduct a comprehensive review of the case and final determination.
• Participate in the appeals process for denied claims through communication with state agencies, applicants and other parties as necessary.
• Efficiently manage a caseload of disability applicants (clients) applying for assistance as a disabled individual through state or private benefit programs.
• Contribute as an active member of a multi-disciplinary team that includes nurses, vocational rehabilitation counselors, physician advisors, and other allied health professionals.
• Participates in and serves as a resource to quality improvement committees, performance improvement initiatives and demonstrates the use of quality improvement in daily operations.
• Maintain the confidentiality of all business documents and correspondence per UMass Chan/ForHealth Consulting procedures and HIPAA regulations.
• Follow all established Procedural Standards and accepted best practices.
• Maintain positive working relationships with applicants, providers, state agencies and other DES clients.
• Document all relevant information into data system applications.
• Comply with all health, safety and program regulations and requirements.
• Perform other duties as required.

Qualifications

REQUIRED QUALIFICATIONS:

• RN - Registered Professional Nurse with current unrestricted license with three years of relevant experience

OR

Masters prepared licensed or certified vocational rehabilitation counselor or other licensed or certified Allied Health professional with 2 years of relevant experience in one or more of the following areas; acute medicine, long term care, mental health, developmental disabilities, substance abuse, rehabilitation and/or vocational counseling or equivalent

• Ability to work in a team environment, interpret state and federal laws and regulations, meet performance deadlines in a dynamic environment.
• Excellent oral and written communications skills.
• Demonstrated experience using computer-based tools including electronic mail, word processing and database products.
• Ability to travel off site as needed