Summary
Location
Westborough
Type
OTHER
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About this role
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
Other facts
About University of Massachusetts Medical School
ForHealth Consulting partners with purposeful organizations, including state Medicaid agencies and health and human services organizations, to make the healthcare experience better for all – more equitable, effective, and accessible. We know that to do this, we need to address every aspect of the system – how we pay for it, how we manage information, and how we deliver quality care to everyone. As part of UMass Chan Medical School, we leverage world-class expertise to create transformational solutions across the health and human services system. ForHealth Consulting believes in the power of collaboration and a shared purpose – together, we can make healthcare better.
What you'll do
- The Disability Reviewer II is responsible for leading and performing diverse work for disability determination agencies, including reviewing medical and vocational evidence. They also manage a caseload of disability applicants and participate in the appeals process for denied claims.
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