POSITION SUMMARY:

The Advisor is responsible for reviewing medical records, constructing functional capacity reports and deciding of disability for applicants seeking benefits based on disability.  Advisors provide clinical guidance to staff.  Advisors oversee the quality of reports and documentation produced by their peers and determine quality improvement initiatives as appropriate. Advisors shall obtain sign-off from a physician on decisions; when necessary.

MAJOR RESPONSIBILITIES:

• Responsible for determining whether an individual applying for benefits as a result of disability meets specific clinical and functional criteria established by federal and state law and regulation.
• Review medical records, approves, or denies recommendations made by staff regarding the disability status of an applicant.
• Advises clinical personnel regarding case development and determines the functional capability of an applicant based upon a comprehensive review of all records.
• Contributes to quality improvement initiatives.
• Participate in quality team case reviews.
• Collaborate with clinical leadership in the interpretation of regulations, development of clinical policies and quality evaluations, provide feedback to peers and other staff regarding clinical policies and the outcomes of quality evaluations, and assist in the development and training.

REQUIRED QUALIFICATIONS: 

• Master’s Level Degree of Science in Nursing (MSN) or Doctor of Nursing Practice (DNP)
• Nurse Practitioner Board Certified
• 3-5 years of experience in direct patient care.

PREFERRED QUALIFICATIONS:

• Experience with MassHealth or Medicaid
• Proficiency in Office Applications