Medicaid Disability Claims Adjudicator

New Mexico Division of Vocational Rehabilitation (NM DVR)

National (OA)

Documents

Individual state requirements may vary. Please contact your local apprenticeship office to ensure this version is suitable to your state’s requirements.

Work Process Schedule

Work Process Content

On the Job Training

Anonymous

OJT hours

Conducting complete case examinations

Evaluate technical issues such as jurisdiction

500

Obtain existing medical and lay evidence

300

Request appropriate evaluations needed to obtain medical evidence

400

Evaluate medical evidence as to quality and sufficiency per medical and legal guidelines

900

Research and interpret complex rules, regulations, policies, procedures and case law

1.3K

Assess residual functional capacity of individual impairments and combinations of impairments and applying those findings to vocational outlook scenarios

900

Generate clear, concise and complete rationales supporting all aspects of case determination

400

Prepare understandable notices to claimants and their representatives explaining the basis for the determination and appeal rights

300

Related Instruction Outline

Related Instruction Content

Training Provider(s):

490

RI hours

Program Orientation & Training Overview

Safety in the workplace

Computer training

Customer Service

Medicaid

Health Insurance Portability and Accountability Act (HIPAA)

Examiner Orientation – Social Security Act

Medical Terminology – Overview

Benefits for the blind

Onset, Duration, Periods of Coverage

Sequential Evaluation – Part 13 Work activity

Case Development

Documentation of Disability

Impairment Severity

MedicalVocational Analysis Introduction

Use of Dictionary of Occupational Titles (DOT)/ Occupational Information Network (O*NET) – Skills and Transferability – Introduction

Attempts (UWA’s)

Ability to do other work

Special issues and case types – Introduction

Using the Vocational Rules – Introduction

Disability Programs, Benefits Categories

Introduction to Function Forms: Residual Functional Capacity (RFC) Mental Residual Functional Capacity (MRFC) Childhood Forms

Adult and childhood rationales

Interpreter Issues

Language and format for listings and body systems

Body System – Adult Listings – Introduction Musculoskeletal Special Senses Respiratory Cardiovascular Digestive Genitourinary Hematological Skin Disorders Endocrine Multiple Body Systems Neurological System Mental Impairments Neoplastic Disease The Immune System

Childhood Disability – Childhood Listing – Introduction Growth Impairments Musculoskeletal System Special sense and speech Respiratory Cardiovascular Digestive Genitourinary Hematological Skin Endocrine Multiple Bodies Neurological

Introduction to Disability Law

Childhood Disability

Caseload determination – intermediate cases

Sequential Evaluation – Part 2

Researching online law libraries

Adult and childhood listings (Intermediate analysis)

Adult and childhood rationales

MedicalVocational Analysis

DOT/O*NET – Skills and transferability (Intermediate cases)

Special Issues and Case Types: Following prescribed treatment and Handling suicide-homicide cases

Using the Vocational Rules (Intermediate cases)

Function forms – Intermediate Residual Functional Capacity (RFC) Mental Residual Functional Capacity (MRFC) Childhood Form

Reconsideration claims

Evaluating technical issues

Obtaining existing medical and lay evidence

Requesting consultative evaluations to obtain medical evidence: Mental disorders

Evaluating medical evidence for quality and sufficiency

Research rules, regulations, policies, procedures and case law

Case development – complex cases

Advanced appellate research techniques

Adult and childhood listings (advanced analysis)

Function forms – multiple impairments Residual Functional Capacity (RFC) Mental Residual Functional Capacity (MRFC) Childhood Form

DOT/O*NET – Skills and transferability (advanced)

Special issues and case types: Hardship, terminally ill and presumptive disability

Continuing Disability Review Claims

Evaluating complex technical issues: multiple issues Obtaining existing medical and lay evidence: employers and Medical specialists

Requesting consultative medical evaluations and diagnostics: Cardiovascular and multiple bodies

Evaluating complex medical evidence for quality and sufficiency

Advanced research of complex regulations and policies

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