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Clinical Reviewer II (Field Based)-OT, part-time
Job Number: 2018-31897
Category: Healthcare
Location: Shrewsbury, MA
Shift: Day
Exempt/Non-Exempt: Exempt
Business Unit: Commonwealth Medicine
Department: Commonwealth Medicine - Disability & Community Service - W401950
Salary Grade: 45
Num. Openings: 1
Post Date: March 15, 2019



Under the general supervision of the Associate Director, or designee, the Clinical Reviewer II is responsible for case consultation by reviewing medical records, assessing the client’s needs, and provide resource support for program participants/applicants. This position ensures that eligible individuals are referred to and receive appropriate services based on medical necessity determinations and program regulations.


  • Contribute as an active member of a multi/inter-disciplinary team to assess, plan, organize, review and evaluate the care needs of applicants/participants requiring health care services, to include outpatient and home based therapy services
  • Conduct on-site visits in order to assess and re-assess the Member’s abilities and medically necessary healthcare needs and services
  • Conduct on-site reviews of Member’s abilities to assist with determining medical necessity for assigned program and health care services
  • Determine and authorize services for applicants/participants in accordance with program guidelines and regulations
  • Review and document all relevant information into data system applications in accordance with program guidelines and regulations
  • Conduct routine and ad-hoc evaluations and re-evaluations of applicants/participants services
  • Contact providers, state agency offices, and clients to obtain information and records needed to conduct a comprehensive clinical review of the case and final determination 
  • Review and document all relevant information into data system applications in accordance with program guidelines and regulations
  • Maintain individual records documenting all applicant/participant encounters and contacts; write clinical summaries
  • Prepare and respond to requests for statistics and resource/service data
  • Foster and promote continuity of care and cooperative partnerships by liaising with health care providers, acute care hospitals and other programs/organizations involved in the provision of services.
  • Participate in public relations efforts, attending conferences and meetings as needed
  • Maintain positive working relationships with applicant/participants, and relevant informal supports, provider organizations, and state agencies
  • Maintain the confidentiality of all business documents and correspondence per UMMS/CWM procedures and HIPAA regulations
  • Participate in performance improvement initiatives and demonstrates the use of quality improvement in daily operations.
  • Comply with established departmental policies, procedures and objectives.
  • Comply with all health, safety and program regulations and requirements.
  • Perform other similar and related duties as required or as directed.


  • OT/PT/RT/SLP licensed to practice in Massachusetts with a Bachelor’s degree in OT/PT/RT
  • or a Master’s degree in SLP
  • Expertise in one or more of the following specialty areas:  acute medicine, long term care, mental health, disabilities or equivalent
  • 5 years’ work experience with at least 3 recent years providing direct service or case management
  • Knowledge of applicable state regulations
  • Ability to travel statewide to applicant/participant homes and service providers places of business
  • Experience with Office Application and database


Extensive experience with program related services/populations. This would include pediatric, brain injury, DME, therapy services, orthotics, prosthetics, PCA and ADLs.


Check Out Our Advancing Careers 
HR Daily Blog
Published Nov. 27, 2018

UMass Medical School Core Competencies demonstrating the capabilities that are central across all UMMS positions that collectively contribute to UMMS success.

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