Clinical Reviewer DMH PASRR (Hybrid; Metro Boston)

Overview:

GENERAL SUMMARY OF POSITION:

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 identity a need for specialized services to the facility, agency, or referrals 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 applicant/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 demonstrates 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 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.