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Clinical Reviewer DMH PASRR - (Hybrid; South Shore/Boston)
Job Number: 2024-47056
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: Sept. 28, 2024
GENERAL SUMMARY OF POSITION:
Under the general supervision of the Associate Director, or designee, the Clinical Reviewer II is responsible for completing Pre-Admission Screening Resident Reviews (PASSR) Level II Evaluations by conducting face-to-face evaluations and reviewing medical records, in accordance with relevant guidelines and regulations. This position ensures that individuals with mental illness (MI), seeking admission to or currently residing in a nursing facility, receive an in-person evaluation and nursing facility placement determination.
MAJOR RESPONSIBILITIES:
* Conduct in-person evaluations to confirm the presence of MI and determine the appropriateness of nursing facility placement and the need for specialized services.
* Complete evaluations prior to nursing facility admissions and for individuals residing in a nursing facility when significant changes occur.
* Ensure evaluations are conducted on an individualized basis, following current federal rules, regulations, and evaluative criteria.
* Communicate evaluation findings to applicants, residents, and/or guardians in an understandable manner.
* Notify facilities and agencies of determinations requiring specialized services within appropriate timelines.
* Gather information and records from providers, state agencies, and applicants/participants for comprehensive clinical reviews.
* Document all relevant information in data systems according to program guidelines and regulations.
* Maintain individual records of applicant/participant encounters and write clinical summaries.
* Respond to requests for statistics and resource/service data.
* Promote continuity of care and partnerships with healthcare providers, hospitals, and other organizations.
* Participate in public relations efforts, attending conferences and meetings as needed.
* Maintain positive relationships with applicants/participants and relevant supports, providers, and agencies.
* Ensure confidentiality of all business documents and correspondence per UMass Chan Medical School/ForHealth Consulting procedures and HIPAA regulations.
* Engage in performance improvement initiatives and apply quality improvement in daily operations.
* Comply with departmental policies, procedures, and objectives.
* Adhere to health, safety, and program regulations and requirements.
* Perform other related duties as required or directed.
REQUIRED QUALIFICATIONS:
* Master's degree in social work, mental health counseling, a related health and human services field, or equivalent OR a registered nurse (RN).
* 5 years of experience providing direct service or case management to adults with psychiatric disabilities, including 1 year in a medical or clinical setting with knowledge of medical terminology. (If a Registered Nurse, must have a minimum of 9 years of collective relevant education and work experience).
* Demonstrated knowledge and experience with relevant social service/rehabilitation systems.
* Knowledge of applicable state and federal regulations.
* Ability to travel statewide.
* Proficient in Microsoft Applications, including Word, Outlook, and databases.
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 in areas such as Long-Term Care, Home Care, Rehab, and/or Disabilities.
* Ability to understand and utilize resources for problem-solving in high-pressure environments.
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