Clinical Reviewer - PASRR

Overview Job Summary Under the general supervision of the Associate Director, or designee, the Clinical Reviewer - PASRR is responsible for reviewing submitted referrals and any accompanying clinical documentation to the Pre-Admission Screening and Resident Review (PASRR) unit for completeness. The Clinical Reviewer- PASRR may also complete Abbreviated Level II evaluations in accordance with relevant guidelines and regulations. This position facilitates individuals with suspected serious mental illness (SMI), seeking admission to or currently residing in a nursing facility, receive an in person or abbreviated evaluation and nursing facility placement determination. Responsibilities Major Responsibilities Participate as an active member of a multi/inter-disciplinary team to evaluate and determine the appropriateness of nursing facility placement for individuals with suspected SMI. Complete thorough review of all referrals and accompanying clinical documentation for completeness and determines if the referral can be moved to an abbreviated or full PASRR Level II evaluation. Demonstrate an ability to use critical thinking skills to identify when to conduct additional outreach or review on assigned cases and when to escalate to assigned supervisor. Complete Abbreviated Level II evaluations on an individualized basis, but in accordance with the most current federal rules, regulations, and evaluative criteria and required timeframes. Review and document all relevant information into data system applications in accordance with program guidelines and regulations. May participate in the preparation of appeals for determinations made through the PASRR process. 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 and other programs/organizations involved in the provision of services. Maintain positive working relationships with individuals served, and relevant informal supports, provider organizations, 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 demonstrates the use of quality improvement in daily operations. Participate in training and mentoring of new clinical reviewer staff. Comply with established departmental policies, procedures and objectives. Comply with all health, safety and program regulations and requirements. May participate in public relations efforts, attending conferences and meetings as needed. Perform other similar and related duties as required or as directed. Qualifications Required Qualifications RN, LPN or social worker licensed to practice in Massachusetts with an appropriate degree 3-5 years’ work experience with at least 3 recent years providing direct service or case management Expertise in working with individuals with mental health behavioral health issues. 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, fast paced environment. Ability to work weekends Preferred Qualifications Extensive experience with program related services/populations preferred Additional Information Supervision Supervision Received Will be supervised by clinical coordinator. Supervision Exercised This position does not include supervisory responsibilities. Environmental Working Conditions Remote position which requires working at computer for all tasks.