Disability Reviewer - Remote Wisconsin

Summary

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 medical, psychological, developmental, and other evidentiary records; apply established Social Security disability criteria; and develop accurate, objective recommendations for disability determinations. You will independently manage a disability caseload while collaborating with reviewers, clinical consultants, supervisors, and program partners to ensure timely and well-supported decisions.

Your role in our mission

• Review and analyze complex medical, psychological, developmental, and functional information to support disability determinations for children applying for or participating in Wisconsin’s Katie Beckett Medicaid program.
• 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.

What we're looking for

• 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.

What you should expect in this role

• 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.
• Access to Gainwell’s competitive benefits package for eligible employees including medical, dental, vision, and 401(k) options in accordance with applicable eligibility guidelines.

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