TENTATIVE

Occ. Code 5206210

New York State Department of Civil Service

Classification Standard

BRIEF DESCRIPTION OF CLASS SERIES

 Disability Review Physicians review and evaluate medical appropriateness of approval or disapproval of requests for disability payments under the Social Security law.

Positions in this title series are placed in the non-competitive jurisdictional class and exist only in the Office of Temporary and Disability Assistance.  

DISTINGUISHING CHARACTERISITICS   

DISABILITY REVIEW PHYSICIAN SPECIALIST:  journey level; review and evaluate medical information on the full range of medical and disability claims submitted for payment under the Social Security law.

SUPERVISING DISABILITY REVIEW PHYSICIAN:  supervise a group of Disability Review Physician Specialists.

RELATED CLASSES

             Disability Review Psychologists review, evaluate and interpret medical information regarding psychological and mental impairments provided in applications for disability benefits under the Social Security law.

              Disability Analysts review individual claims for disability benefits under the provisions of Title II and Title XVI of the Social Security Act and special programs to determine eligibility for such benefits.  Analysts are responsible for the review, evaluation and adjudication of initial, continuing and other disability claims.

ILLUSTRATIVE DUTIES

DISABILITY REVIEW PHYSICIAN SPECIALIST

•  Review completed disability cases to evaluate the medical evidence to determine its adequacy in supporting the decision made; assess the validity of medical impairments to ensure appropriate disability determinations have been made.

• Provide advice and consultation to the review staff in determining the needs for consultative examinations and recommend alternate approaches for obtain required medical evidence if it appears such examinations are not necessary.

• Interpret medical terminology and the application of medical evidence in the disability determinations process.

• Assist the review staff in developing and improving relations with the medical profession to improve the flow of needed supportive medical documentation and to minimize case processing time.

• Provide training to review staff in consultation with the agency training staff in evaluation and interpretation of medical reports, data and examination results.

• Review disability determinations to ensure the integrity of decisions based on the medical evidence and approve all such determinations.

• Refer questionable cases back to the appropriate Disability Analyst staff for reworking; and refer back those cases where the medical evidence does not seem to support the conclusions drawn.

SUPERVISING DISABILITY REVIEW PHYSICIAN  

• Review completed review physicians work to determine adequacy of medical documentation on which the decision is based, appropriateness of additional medical evidence required, and special tests selected to determine clients eligibility for disability benefits.

• Guide and assist subordinate physicians and staff in application of guidelines used in adjudicating disability claims, ensuring a uniformity of approach to the disability process.

• Facilitate the exchange of information between the medical staff and review staff.

• Confer with and assist staff in review of the most complex disability cases to determine the need for special medical evidence; assist in making necessary arrangements for the purchase of such evidence.

• Prepare rebuttals to comments by the Social Security medical staff when they return claims for further consideration.

 MINIMUM QUALIFICATIONS   

            DISABILITY REVIEW PHYSICIAN SPECIALIST 

A license to practice medicine and Board Certification or Board Certification Eligible; or possession of a Workers Compensation Specialty Rating.

            SUPERVISING DISABILITY REVIEW PHYSICIAN

One year of experience as a review physician in an organization whose primary function is the adjudication of claims for disability benefits under Sections 2 and 16 of the Social Security Law OR a license to practice medicine in the United States; Board Certification or Board Certification Eligible; or possession of a Workers Compensation Specialty rating; and two years of supervisory experience.

Date:  3/10

NOTE: Classification Standards illustrate the nature, extent and scope of duties and responsibilities of the classes they describe. Standards cannot and do not include all of the work that might be appropriately performed by a class. The minimum qualifications above are those which were required for appointment at the time the Classification Standard was written. Please contact the Division of Staffing Services for current information on minimum qualification requirements for appointment or examination.