Disability Reviewer - Remote Wisconsin

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.

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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The pay range for this position is $50,700.00 - $72,400.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.