Overview
Under the general supervision of the Associate Director, or designee, the Nurse Reviewer II is responsible for completing in-person assessments and reviewing supporting documentation to determine clinical eligibility for individuals who are residing in the community receiving services through the Family Assistance Pathway. Additionally, the Nurse Reviewer II provides education to MassHealth members on the next steps in the MassHealth eligibility process.
Responsibilities
Provide outreach to members to schedule visits in a timely manner. Conduct on-site assessments of members medical, functional, psychosocial, and supportive needs to determine clinical eligibility completing the MDS-HC assessment and associated forms. Review and document all relevant information into data system applications in accordance with program guidelines and regulations. Utilizes critical thinking skills to complete written, clinically based comprehensive assessments that accurately depict the members needs, without bias. Review and document all relevant information into data system applications in accordance with program guidelines and regulations. Maintain individual records documenting all member encounters and contacts.
Participate in public relations efforts, attending conferences and meetings as needed. Maintain positive working relationships with members, and relevant formal/informal supports, provider organizations, program consultants and state agencies. Maintain the confidentiality of all business documents and correspondence per UMass Chan Medical School (UMass Chan)/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. Participates in training and onboarding of new clinical staff State-wide travel is required for this position. Perform other duties as required.
Qualifications
Bachelor s Level Degree in Nursing RN with current licensure to practice in Massachusetts 5-7 years of related work experience Knowledge of applicable state regulations Ability to travel statewide Experience with Office Application and database
Additional Information
Preferred Qualifications:
Experience with disabled or long term care populations Experience completing MDS or MDS-HC assessments Experience in one of the following areas: Long-Term Care, Home Care, Rehab, and/or Disabilities Bilingual in Spanish