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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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