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Clinical Reviewer DMH PASRR - (Hybrid; South Shore/Boston)
Job Number : 2025-47685
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 : Jan. 31, 2025
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:
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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Job Tags
Full time, Work experience placement, Shift work,