Disability Reviewer II

University of Massachusetts Medical School; Westborough (MA); In loco; USD 85.000 - 100.000; Tempo pieno

Descrizione del lavoro

University of Massachusetts Medical School seeks a Disability Reviewer II to lead diverse disability determinations for state agencies and related entities. You will gather medical, psychiatric and vocational evidence, review state statutes and guidelines, and determine benefit eligibility in accordance with laws and regulations.

The role requires clinical licensure or credentialing and 2–3+ years of relevant experience; candidates collaborate with a multidisciplinary team and participate in

Competenze

• RN license with three years of relevant experience.
• Master’s prepared licensed or certified rehabilitation counselor or equivalent with 2+ years in relevant areas.
• Ability to work in a team environment and interpret laws/regulations.
• Excellent oral and written communication skills.
• Experience using computer-based tools including email, word processing and databases.
• Willingness to travel off site as needed.

Mansioni

• Lead and perform diverse work for disability determination agencies and related entities.
• Contact providers, state agency offices, case managers and clients to obtain information and records.
• Participate in appeals process for denied claims.
• Manage a caseload of disability applicants.
• Collaborate with nurses, vocational rehabilitation counselors, physician advisors and other professionals.
• Contribute to quality improvement initiatives and maintain HIPAA compliance.
• Maintain confidentiality of all business documents and records.

Conoscenze

Teamwork

Regulatory knowledge

Communication

Caseload management

Travel willingness

Formazione

RN license

Master’s in rehab counseling

Strumenti

Email

Word processing

Database software

Descrizione del lavoro

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 statutes 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