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Clinical Reviewer II - PASRR - Western, MA (Home Office/Client Visits)
Job Number: 2023-42642
Category: Healthcare
Location: Shrewsbury, MA
Shift: Day
Exempt/Non-Exempt: Exempt
Business Unit: ForHealth Consulting
Department: ForHealth Consulting - Community Service - W401950
Job Type: Full-Time
Salary Grade: 45
Num. Openings: 1
Post Date: April 19, 2023

GENERAL SUMMARY OF POSITION: 

Under the general supervision of the Associate Director, the Clinical Reviewer II is responsible for completing Pre-Admission Screening Resident Reviews (PASRR) Level II Evaluations by conducting face to face evaluations and reviewing medical records, in accordance with relevant guidelines and regulations. This position plays a key role in ensuring that individuals with Serious Mental Illness (SMI), seeking admission to or currently residing in a nursing facility, receive an in-person evaluation to determine the least restrictive setting to meet their needs and recommend services needed to support individuals unique medical and behavioral health needs. 

MAJOR RESPONSIBILITIES:

  • Upon suspicion of MI conduct in-person evaluations to confirm the presence of MI, whether a nursing facility is the most appropriate setting and whether the individual has a need for specialized services.
  • Conduct completed evaluations prior to individuals nursing facility admissions; completed evaluations on individuals residing in a nursing facility when there are significant changes that signify the need for an updated evaluation.
  • Complete evaluations on an individualized basis, but in accordance with the most current federal rules, regulations, and evaluative criteria.
  • Communicate all evaluation findings to applicants, residents and/or guardians in an understandable manner and language.
  • Communicate determinations that identity a need for specialized services to the facility, agency, or referrals source, within appropriate timelines and data transmission policies.
  • Contact providers, state agency offices, and applicants/participants 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, long term care facilities 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, program consultants and state agencies
  • Maintain the confidentiality of all business documents and correspondence per UMass Chan/ForHealth Consulting 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.

REQUIRED QUALIFICATIONS:

  • Masters degree in social work; mental health counseling; related health and human services field; or equivalent OR a registered nurse (RN).
  • 5 years of work experience providing direct service or case management to adults with psychiatric disabilities inclusive of 1 year of experience in a medical or clinical setting with knowledge of medical terminology. (If a Registered Nurse, must have a minimum 9 years of collective relevant education and work experience as outlined above).
  • Demonstrated knowledge and experience with relevant social service/rehabilitation systems.
  • Knowledge of applicable state and federal regulations
  • Ability to travel statewide.
  • Proficient in the use of Microsoft Applications, including Word, Outlook and database

PREFERRED QUALIFICATIONS:

  • Massachusetts licensed Psychologist, Licensed Social Worker, Certified Rehabilitation Counselor or other licensed professional.
  • Experience with disabled or long term care populations
  • Experience in community mental health services and one of the following areas: Long-Term Care, Home Care, Rehab, and/or Disabilities.
  • Ability to understand and utilize resources for problem solving, in order to deal with problems involving multiple variables, effectively prioritizing and executing tasks in a high-pressure environment.

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