[Remote] Clinical Reviewer - PASRR

Note: The job is a remote job and is open to candidates in USA. ForHealth Consulting at UMass Chan Medical School is seeking a Clinical Reviewer - PASRR responsible for reviewing referrals and clinical documentation for the Pre-Admission Screening and Resident Review unit. The role involves evaluating nursing facility placements for individuals with suspected serious mental illness and conducting evaluations in compliance with federal guidelines.

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

Skills

• 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
• Extensive experience with program related services/populations preferred

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