Disability Reviewer Business Specialist - Hybrid

Under the general direction of the Executive Director or designee, the Disability Reviewer Business Specialist is responsible for supporting disability determination business development including, but not limited to, drafting responses to Requests for Proposals (RFP) or client-requested proposals, leading discovery sessions with potential clients, assisting in systems development/training, onboarding new clients, training activities related to new client processes and development of workflows, processes, and procedure. This position will also assist the Executive Director or designee in monitoring and assuring program compliance for all contracts within Disability Evaluation Services. Leads and performs diverse work for multiple State disability determination agencies and Public Retirement Systems and may support assessments or clinical reviews across other ForHealth Consulting business units or Massachusetts 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.

Draft RFP responses or client-requested proposals.
Participate in client discovery sessions to include learning the disability determination or related process, reviewing current documents and forms, and maintaining accurate records of session discussions and decisions.
Parter with clients to develop and continuously revise program processes and procedures that align with the ForHealth business model and client requirements.
Construct detailed Top-Down documents that act as the roadmap for IT development and business process workflows.
Develop and revise forms and correspondence for new program implementation.
Provide subject matter expertise to IT for the development of a proof of concept for new program implementation.
Work with IT Business Analysts to develop detailed user stories for system development for new program implementation.
Conduct User Acceptance Testing for business user roles and workflows for new program implementation.
Develop training materials for all staff on new projects to include meticulous workflows, guides, PowerPoints, overview materials, etc.
Train and act as preceptor/mentor for all clinical and administrative staff including Disability Assistants, Disability Reviewers, Physician Advisors, and management level employees on all aspects of new programs including policies, procedures, workflows, IT systems, etc.
Work with management to identify and document scope updates for semi-annual reviews with clients.
Research and draft agency procedural standards in accordance with relevant State and Federal regulations.
Provide expert content material toward RFP deliverables or proposal development.
Collaborate with identified staff to assist in the development and presentation of training initiatives designed to improve accuracy and quality of the review process.
Monitor regulations that guide disbaility determinations
Lead performance improvement initiatives.
Perform quality improvement activities.
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 and ForHealth Consulting procedures and HIPAA regulations.
Assume responsibility for being an emergent intervention agent when confronted with a client in a crisis situation.
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.

REQUIRED EXPERIENCE
RN license to practice the Commonwealth of Massachusetts with five years of relevant experience or Masters prepared licensed or certified vocational rehabilitation counselor or other licensed or certified Allied Health professional in the Commonwealth of Massachusetts.
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.