Disability Reviewer II-Remote

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

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