Clinical Reviewer DMH PASSR - (Hybrid; South Shore/Boston)
Minimum Salary: US-MA-Shrewsbury
Job Location: 2 weeks ago (10/7/2024 4:36 PM)
Requisition Number: 2024-47056
# of Openings: 1
Posted Date: Day
Shift: Exempt
Overview
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.
Responsibilities
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, 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.
Qualifications
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 of 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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