Job Description

Under the general direction of the Associate Director, or designee, the Clinical Coordinator (Team Lead) is responsible to develop, prioritize, and oversee staff activities that support Pre-Admission Screening Resident Reviews (PASRR) for individuals seeking nursing facility admission. This position ensures that Clinical Reviewers complete assessments based on state and federal regulations for individuals suspected/confirmed to meet criteria for serious mental illness (SMI), need for nursing facility services and appropriateness of placement in a nursing facility, as well as the need for specialized services or additional behavioral health services. This position provides leadership for the ongoing development of clinical competence and practice. In collaboration with colleagues, this position will supervise and implement improvements to clinical review activities.

Responsibilities

Major Responsibilities

• Provide clinical direction, supervision, and support to the clinical reviewer team performing evaluations of individuals applying to nursing facilities.

• Supervise the evaluation and assessment of eligibility requirements, including PASRR Level II evaluations, consistent with established procedural standards, program rules and regulations to monitor provider compliance.

• Review and complete categorical determination requests within specified timeframes.

• Assist in Clinical Reviewer case assignment, review and finalization processes.

• Participate in on-site visits to nursing facilities and community based-locations, as necessary.

• Collaborate with other applicable State Agencies regarding identified issues of various populations.

• Research regulations and interpret these regulations for providers, agencies and staff.

• Provide clinical support to program managers, and design and present training sessions for in-house staff or community-based providers as necessary.

• Review and propose changes to applicable program regulations, policies, and other documents.

• Coordinate contacts with providers to respond to inquiries pertaining to specific program areas, including acute care facilities and nursing facilities for pre-admission screening and resident review.

• Oversee data integrity measures by reviewing and documenting all relevant information into data system applications in accordance with program guidelines and regulations.

• Conduct routine and ad-hoc evaluations and re-evaluations of applicant’s/individual’s services.

• Support staff in contacting providers, state agency offices, and applicants/individuals to obtain information and records needed to conduct a comprehensive clinical review of the case and final determination.

• 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.

• Foster team environment, and provide professional and clinical leadership to team members, including consultants, providers and administrative support staff as appropriate.

• Direct team members in identifying and addressing issues involving clinical matters.

• Interface with contractors regarding clinical determination of medical necessity and program compliance.

• Communicate policy, workflow and organizational changes to team members.

• Provide orientation and ongoing in-service/continuing education programs for team members.

• Conduct performance evaluations of team members.

• Participate in the hiring and termination of team members.

• Work closely with Associate Director and other management staff to ensure clinical integrity is maintained in the PASRR process

• In collaboration with the Director and other management staff, coordinate performance improvement and quality assurance activities.

• Prepare written reports/determinations as requested.

• Travel to and from providers’ places of business and state agency offices.

• Perform other related duties as required or directed.

Qualifications

Required Qualifications

• Bachelor's Degree in social work, mental health counseling, RN or a related health and human services field.

• 5-10 years of work experience providing direct service or case management to adults with mental health and behavioral health inclusive of 1 year of experience in a medical or clinical setting with knowledge of medical terminology.

• At least 2 years of recent supervisory or management experience in a clinical setting.

• 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.

• Ability to work weekends as on-call supervisor.

Preferred Qualifications

• Master's Degree in social work, mental health counseling, RN or a related health and human services field.

• Licensed Social Worker, Licensed Mental Health Counselor, Certified Rehabilitation Counselor, Registered Nurse or other licensed professional in a related field.

• Experience with mental health and behavioral health and/or long term care populations

• Experience in one of the following areas: community mental health services, Long-Term Care, Home Care, skilled nursing and rehab

• 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

Additional Information

Supervision

Supervision Received

Supervision received from Associate Director

Supervision Exercised

Team Lead

Environmental Working Conditions

Remote/desk work with- some statewide travel may be required