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GENERAL SUMMARY OF POSITION:

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 clients seeking nursing facility admission. This position ensures that clinicians complete assessments based on medical necessity determinations and state and federal regulations.  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. 

MAJOR RESPONSIBILITIES:

• Provide clinical direction, supervision, and support to the clinical review 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.
• 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 applicants/participants services.
• Support staff in contacting 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.
• 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 Director and other management staff to ensure clinical integrity is maintained in the clinical eligibility and nurse reviewer processes.
• 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.

REQUIRED QUALIFICATIONS:

• 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).
• 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

PREFERRED QUALIFICATIONS:

• 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.