[Hiring] Disability Reviewer @Gainwell Technologies LLC

Role Description

Join Gainwell as a Disability Reviewer supporting Wisconsin’s Katie Beckett Medicaid program, which serves eligible children with disabilities and complex medical needs. In this role, you will:

• Review and analyze complex medical, psychological, developmental, and functional information to support disability determinations for children.
• Develop disability determination recommendations using medical evidence, functional limitations, applicable Social Security Act requirements and disability criteria, established policies, regulations, procedures, and quality standards.
• Evaluate medical terminology, disease processes, diagnostic testing, treatment practices, physical and mental impairments, and other relevant evidence, identifying when additional medical information is necessary to complete a review.
• Prepare clear and accurate electronic case documentation, written review requests, case summaries, determination records, and required notifications while maintaining confidentiality and complying with applicable regulations and program requirements.
• Independently manage an assigned disability caseload and collaborate with reviewers, clinical consultants, supervisors, and operational partners to research discrepancies, resolve complex cases, and reach logical and objective conclusions.

Qualifications

• Professional experience working with children who have disabilities and/or complex medical needs, with the ability to evaluate medical, emotional, psychological, developmental, and functional conditions.
• Experience reviewing and analyzing medical, psychological, developmental, clinical, or other evidentiary records and using detailed information to develop logical, objective, and well-supported recommendations.
• Strong analytical, critical-thinking, written communication, organizational, and attention-to-detail skills with the ability to independently manage priorities, deadlines, and a disability-related caseload accurately and timely.
• Bachelor’s degree in a human services-related field with relevant clinical experience, or an associate degree in a human services-related field with equivalent relevant experience; backgrounds in nursing, psychology, social work, human services, or related therapies are preferred.
• Strong computer skills and ability to work effectively with electronic medical and evidentiary records; experience with CARES Worker Web (CWW) is preferred.

Requirements

• Full-time, 100% remote position; applicants must reside within Wisconsin and work 40 hours per week.
• Work Monday through Friday with required availability during Wisconsin Department of Health Services core working hours of 9:00 a.m.–3:00 p.m. Central Time.
• Quarterly travel to Madison, Wisconsin is required for meetings or other business needs.
• Maintain a private, distraction-free workspace and reliable hard-wired high-speed internet connection with a minimum of 25 Mbps download and 10 Mbps upload; Wi-Fi is not permitted as the primary connection.

Benefits

• Access to Gainwell’s competitive benefits package for eligible employees including medical, dental, vision, and 401(k) options in accordance with applicable eligibility guidelines.
• Generous, flexible vacation policy.
• 401(k) employer match.
• Comprehensive health benefits.
• Educational assistance.
• Variety of leadership and technical development academies to help build your skills and capabilities.