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Clinical Reviewer DMH PASSR - (Hybrid; North Shore/Metro Boston)
Job Number: 2024-47055
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: Oct. 7, 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:
* 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 identify a need for specialized services to the facility, agency, or referral 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 applicants/participants, and relevant informal supports, provider organizations, program consultants, and state agencies.
* Maintain the confidentiality of all business documents and correspondence per UMass Chan Medical School/ForHealth Consulting procedures and HIPAA regulations.
* Participate in performance improvement initiatives and demonstrate 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:
* Master's 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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