[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.ResponsibilitiesParticipate as an active member of a multi/inter-disciplinary team to evaluate and determine the appropriateness of nursing facility placement for individuals with suspected SMIComplete 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 evaluationDemonstrate 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 supervisorComplete Abbreviated Level II evaluations on an individualized basis, but in accordance with the most current federal rules, regulations, and evaluative criteria and required timeframesReview and document all relevant information into data system applications in accordance with program guidelines and regulationsMay participate in the preparation of appeals for determinations made through the PASRR processPrepare and respond to requests for statistics and resource/service dataFoster 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 servicesMaintain positive working relationships with individuals served, and relevant informal supports, provider organizations, and state agenciesMaintain the confidentiality of all business documents and correspondence per UMass Chan Medical School/ForHealth Consulting procedures and HIPAA regulationsParticipate in performance improvement initiatives and demonstrates the use of quality improvement in daily operationsParticipate in training and mentoring of new clinical reviewer staffComply with established departmental policies, procedures and objectivesComply with all health, safety and program regulations and requirementsMay participate in public relations efforts, attending conferences and meetings as neededPerform other similar and related duties as required or as directedSkillsRN, LPN or social worker licensed to practice in Massachusetts with an appropriate degree3-5 years work experience with at least 3 recent years providing direct service or case managementExpertise in working with individuals with mental health behavioral health issuesAbility 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 environmentAbility to work weekendsExtensive experience with program related services/populations preferredCompany OverviewForHealth Consulting partners with purposeful organizations, including state Medicaid agencies and health and human services organizations, to make the healthcare experience better for all – more equitable, effective, and accessible. It was founded in undefined, and is headquartered in Westborough, Massachusetts, US, with a workforce of 501-1000 employees. Its website is https://forhealthconsulting.umassmed.edu/.