Medical Quality Assurance Manager

The Medical Quality Assurance Manager shall train and report on the work progress of qualified personnel referred to as Medical Consultants and Psychological Consultants (MC/PC) who will provide quality assurance of medical reviews and assessments on disability cases in the specialties of General Medicine, Internal Medicine, Psychology, and Psychiatry for the Social Security Administration (SSA).

Responsibilities

• Facilitate, conduct and participate in mentoring or training activities with other MCs/PCs
• Provide insight and guidance to MC/PCs for ongoing training and offer consultative support for initial training and orientation.
• Keep current on SSA policy and medical research for successful reviews of medical assessments.
• Review all medical and non-medical evidence of record; including any prior file information.
• Review MC/PC interpretation of all medical evidence, ensuring all current SSA disability policies and procedures are followed, to include mental health.
• Request additional evidence, only when the evidence in the file is insufficient to assess in accordance with current SSA disability policies and procedures.
• Ensure composition of medical assessments (or opinions) are in a professional manner, in a formal tone (third person), free of jokes, personal anecdotes, emotion, biases, prejudices or colloquial expressions.
• Review and assess written independent narrative conveys individualized review in a clear and concise manner.
• Ensure independent case reviews are completed within time frames established by the COR.
• Consult with staff and others (e.g., other MCs/PCs, medical providers, or Medical Advisors) as needed for the review of the case.
• Ensure findings are recorded in the agency electronic processing systems as specified by SSA case review policies and procedures.
• Attend required meetings, briefings, and workgroups necessary to perform independent case reviews (e.g., policy updates, procedural changes) or to discuss administrative issues related to the contract.
• Respond to all communications including, instant message or email.
• Ensure satisfactory written assessments are accomplished by MC/PCs, free of spelling and grammatical errors that can be used by others in the disability program.
• Ensure required corrections are made to medical assessments when returned from the Office of Quality Review (OQR).
• Report suspected fraud identified in the course of the medical assessment.
• Participate in presentations, as needed.
• Provide consultation and expertise on policy development issues including written and/or oral summarizations.
• Participate in workgroups, visits, and meetings as requested by SSA to discuss issues related to the disability process; e.g., new medical technologies, revision of medical listings, and other policy issues (this does not include meetings, briefings, or workgroups necessary for independent case reviews); and
• Other duties as assigned.

Qualifications

• Doctorate of Medicine or Osteopathy from an accredited college approved by the Council of Medical Education and Hospitals of the American Medical Association or Doctor of Osteopathy from a college accredited by the American Osteopathic Association.
• Possess and maintain a Valid unrestricted license to practice medicine within one of the 50 states, the District of Columbia, Puerto Rico, or the U.S. Virgin Islands.
• Minimum three (3) year experience practicing medicine within the last seven (7) years in one of the following specialties: Internal Medicine OR General Medicine.

Knowledge, Skills and Abilities

• Experience working in the disability policy community, either from a medical or legal perspective.
• Experience serving as a Medical Expert with the SSA, Preferred.
• Experience with SSA Title 2 and Title 16 programs, Preferred.
• Ability to organize and effectively administer training covering complex and technical content to professionals.
• Ability to read, write, and speak English well enough to effectively communicate with all parties and other health care providers.
• Shall be computer literate.
• Knowledge of the required education, training, experience, and documented current competence in the required specialty position description.
• Possess sufficient initiative, interpersonal relationship skills and social sensitivity such that he/she can relate constructively to a variety of patients from diverse backgrounds.
• Ability to write in a clear, concise, grammatically correct manner.
• Knowledge and excellent computer skills including the use of computer software applications for drafting documents, data management, and tracking. This includes competency with Microsoft Office (Word, Excel, Outlook, PowerPoint).