Hybrid Clinical Reviewer II - PASRR (Southeast Region in MA) presso Un – USA Remote Jobs
- Upon suspicion of SMI conduct in-person evaluations to confirm the presence of SMI, whether a nursing facility is the most appropriate setting and whether the individual has a need for behavioral health, rehabilitative or 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;completed annual evaluations for individuals who have a previously confirmed SMI; complete abbreviated desk reviews as indicated or needed
- Complete evaluations on an individualized basis within required timeframes, and in accordance with the most current federal rules, regulations, and evaluative criteria
- Communicate all evaluation findings to applicants, residents and/or legally authorized representatives in an understandable manner and language
- Communicate determinations that identity a need for specialized services and/or behavioral health 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
- Support in the preparation and responses 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 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