Disability Reviewer II

University of Massachusetts Medical School•Westborough, MA

About The 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 and reviews for the Office of Clinical Affairs and other UMass Chan Medical School entities or State agencies. Reviews may include medical and psychiatric evidence, vocational profiles, state statutes and guidelines, and other pertinent evidence to determine whether an individual meets standards under applicable state and federal laws and regulations. These determinations may result in the awarding or denial of benefits to an applicant or retiree.

Requirements

Registered Professional Nurse (RN) with a current unrestricted license and three years of relevant experience; OR a master's-prepared licensed or certified vocational rehabilitation counselor or other licensed or certified Allied Health professional with two years of relevant experience in one or more of the following areas: acute medicine, long-term care, mental health, developmental disabilities, substance abuse, rehabilitation, or vocational counseling, or equivalent.
Ability to work in a team environment, interpret state and federal laws and regulations, and meet performance deadlines in a dynamic environment.
Excellent oral and written communication skills.
Demonstrated experience using computer-based tools, including electronic mail, word processing, and database products.
Ability to travel off site as needed.

Responsibilities

Serve as 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 for comprehensive case reviews and final determinations.
Participate in appeals processes for denied claims, communicating with state agencies, applicants, and other parties as necessary.
Efficiently manage a caseload of disability applicants seeking assistance through state or private benefit programs.
Contribute as an active member of a multidisciplinary team, including nurses, vocational rehabilitation counselors, physician advisors, and other allied health professionals.
Participate in and serve as a resource to quality improvement committees and performance improvement initiatives, and use quality improvement in daily operations.
Maintain confidentiality of business documents and correspondence according to UMass Chan/ForHealth Consulting procedures and HIPAA regulations.
Follow established Procedural Standards and accepted best practices.
Maintain positive working relationships with applicants, providers, state agencies, and other DES clients.
Document relevant information in data system applications.
Comply with health, safety, and program regulations and requirements.
Perform other duties as required.