ForHealth Consulting at UMass Chan Medical School · 6 hours ago
Pre-Admission Screening & Resident Reviewer (MetroWest Region in MA)
Westborough, MA
Full-time
Hybrid
Senior Level
5+ years expForHealth Consulting at UMass Chan Medical School partners with organizations to improve healthcare experiences. The Clinical Reviewer II will conduct evaluations for individuals with mental illness seeking nursing facility admission, ensuring compliance with relevant guidelines and regulations.
Management Consulting
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
Qualification
Required
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
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
Benefits
State benefits
Company
ForHealth Consulting at UMass Chan Medical School
ForHealth 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.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Carly Gould
Senior Human Resources Business Partner
Jatin Dave
Chief Medical Officer, MassHealth
Company data provided by crunchbase