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Case Reviewer 

 

Purpose:   A Case Reviewer conducts quality assurance reviews of sampled cases to ensure integrity, efficiency, and regulatory compliance with county, state, and federal regulations.

 

Functions: The Case Reviewer identifies and classifies issues to measure case accuracy leading to program improvement. 

 

  • Collects and analyzes case record information to ensure actions comply with program rules. 

    • Evaluates case records and information systems to determine if appropriate actions based on policy and procedures were taken. 

    • Determines the causal factors for incorrect actions.

    • Documents both correct and incorrect actions.

  • Collects and researches applicable agency policies and procedures.

  • Collects and researches applicable federal regulations. 

  • Performs other work as assigned.
     

Reporting Relationships:  Reports to a higher-level manager. Collaborates effectively with other team members.

 

Challenges:  Challenges include ensuring that case records are thorough and accurate. If a case is determined to be incorrect, the reviewer must cite why and be able to substantiate their reasoning by identifying appropriate federal, state or other policy and/or procedure. Critical thinking skills are required to determine accuracy when the situation is not well defined, and adapting to changing policies and review requirements. 

 

Knowledge and Abilities:

 

Knowledge of:

  • Public assistance programs

  • Microsoft Office Products

 

Ability to:

  • Self-motivate and work independently with minimal supervision.

  • Communicate information clearly and concisely.

  • Schedule and manage work time by assigning appropriate priorities to work activities based on organizational goals. 

  • Maintain confidentiality of case records.

  • Navigate multiple computer systems and utilize other computer applications. 

  • Analyze and evaluate case records and system information for compliance with relevant federal and state regulations.

  • Perform basic mathematics.

  • Use independent decision making on appropriate processes in accordance with standard procedures.

  • Effectively communicate recommendations to ensure fidelity to the review processes or streamline actions or activities.


Education and Experience:  Experience in working with public assistance programs. Bachelor’s Degree preferred.

Policy/Systems Analyst

 

Purpose:  The Systems Analyst is dedicated to collaborating closely with Rushmore’s private, public, and governmental customers. The primary objective is to provide comprehensive support for our quality control services in our case review systems, ensuring seamless integration and functionality. The successful candidate will play a critical role in optimizing our technology solutions to enhance accuracy within the social and human service areas.

 

Functions of this position include: 

 

Customer Engagement:

  • Schedule and actively participate in customer meetings, ensuring effective and proactive communication.

  • Facilitate work sessions to analyze policy or procedural changes for system impact and create functional requirements documentation.

  • Act as the primary contact for prospect and customer inquiries.

  • Conduct training sessions and product demonstrations for prospects and customers.
     

Policy and Technical Development:

  • Research and evaluate regulatory and policy impacts across social, health, and human service programs to support the development team and customer on system design and reporting.

  • Monitor and analyze functional requirements implementation and identify impact assessments and recommendations.

  • Monitor and resolve reported issues within contracted timelines.

  • Prepare comprehensive Statements of Work for project scopes and deliverables.

  • Engage in daily meetings and contribute to company-wide discussions.

  • Coordinate, develop, and update user documentation, training guides, and user manuals.

 

Testing Standards and Guidelines:

  • Oversee and lead internal testing to ensure applications are stable, functional, and user-friendly.

  • Document bugs and other errors not adhering to functional requirements.

  • Develop and maintain standards for consistent testing processes.

  • Regularly communicate with the Development Team, Testing Team, and User Acceptance Testers to uphold standards.

  • Test and retest system configurations to ensure quality deliverables consistent with organizational values and standards.

  • Validate releases against initial requirements. 

 

Reporting Relationships: Reports to the Development Program Manager, works closely with Rushmore’s Development Team staff, and Testing Team and oversees user acceptance testing activities.

 

Challenges: Research and design new solutions blending state-of-the-art technology with existing systems. Overcome challenges in translating customer needs, planning for future enhancements, and adhering to project timelines.

 

Contact with Others: Frequent communication with customers, programmers, testers, and management. 

 

Working Conditions: A typical office environment.  May require travel to the customer site.

 

Knowledge and Abilities:

 

Knowledge of:

  • In-depth understanding of health, human and social systems.

  • Familiarity with project management methodologies and change management principles.

  • Strong communication and leadership skills.

 

Ability to:

  • Correctly interpret and analyze federal/state laws and policies and make informed recommendations.

  • Operate across multiple projects simultaneously. 

  • Take initiative and be self-motivated. 

  • Develop system documentation and customer training.

  • Establish and maintain effective working relationships.

  • Communicate information clearly and concisely.
     

Education and Experience:

Combination of 4+ years of education and/or relevant experience. Bachelor’s Degree preferred.

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