Job Specification

Purpose of Position :

To provide disability adjudication services, including analysis of decision, for applicants applying for benefits under the Ontario Disability Support Program (ODSP) in a multi-disciplinary team environment consisting of clinical professionals including nurses, occupational therapists, physical therapists, clinical psychologists, rehabilitation specialists and others with equivalent medical training.

Duties / Responsibilities :

In a centralized adjudication system, the incumbent provides specialized disability adjudication including triage, initial, internal review, social benefits tribunal (SCBT), re-assessment and re-application for ODSP applicants by performing tasks such as:

1. Provides Disability Adjudication Services by:

- Reviewing and assessing applicant documentation packages consisting of medical, and psychiatric diagnoses and prognoses reports (Health Status Report and Activities of Daily Living Report) against the legislation to determine client eligibility for benefits under the ODSPA.
- Consulting with physician and other medical and non-medical professional to obtain and clarify information.
- Assessing, analyzing, interpreting and evaluating medical conditions and their impact based on information submitted such as: radiology, special consultations, oncology, chemotherapy, surgery, psychopharmacology treatments, psychiatry, psychology and rehabilitation to determine disability. Adjudication g the medical documentation against the legislation using the adjudication manual, guidelines and directives; discussing complex issues/cases with the Adjudication Manager and when necessary the Chief Medical Advisor preparing comprehensive medical summaries and decisions to support the adjudication decision that will withstand scrutiny during the appeals process.
- Independently adjudicating where an internal review has been requested by the applicant.
- Reviewing the file in its entirety and writing a summary decision to use for SBT appeals when required.
- Where appropriate, identify adjudication summary and/or file issues.
- Adjudicating the required documentation regarding the clients continuing eligibility for benefits under ODSPA after a 2 year or year review period which could entail making sensitive decisions.
- Communicating and consulting as needed with the Adjudication Manager, the Chief Medical Advisor and other adjudicators in a multidisciplinary team regarding adjudication, decisions, identifying and justifying to the issues; obtaining and sharing information with counterparts in other Ministries and in other health care disciplines.
- Along with the Adjudication Manager, identify ongoing learning needs regarding clinical conditions, new medical research and the impact on activities of daily living; identify and utilize medical references/resources (texts, internet and health professionals) to adequately meet identified learning needs.

2. Provides Administrative and Other Services such as:

- Managing a large volume of files to ensure that time frames for adjudication are met.
- Providing to the clerks the decision and the appropriate draft letters to advice applicants and ODSP/OW offices of decisions.
- Assisting Manager with staff orientation and training when requested.
- Attend and participate in unit meetings, clinical education rounds, and administrative meetings
- Respond to telephone inquiries from doctors and others related to the adjudication process.
- Perform other duties as assigned.

Knowledge :

Significant clinical knowledge and experience with medical psychiatric or social issues; treatments and programs and services provided by adult medical, psychiatric or rehabilitation settings. Significant knowledge of physical and mental impairments and their impacts on activities of daily living in the home, community and workplace normally acquired through a recognized university program leading to a Masters degree or equivalent in nursing; occupational therapy, or Health Science or a Masters degree in clinical psychology in rehabilitation or with equivalent medical education. Strong analytical, clinical judgement, problem solving and decision making skills to review disability documentation in conjunction with a manual and the legislated definition; excellent oral and written communications kills to ensure liaison with professionals and to write reports. Ability to make independent decisions regarding disability determination. Ability to evaluate, analyze and interpret a variety of medical documentation. Ability to keep informed of new medical research and the impact on activities of daily living through the identification and utilization of medical resources such as texts, Internet and other health professional to adequately meet learning needs. Computer literacy essential to utilize technology supports. Investigative skills to determine and retrieve appropriate information regarding specific conditions. Excellent organizational and interpersonal skills and ability to work effectively with a team.

Skills :

(Included in Knowledge section)