Nurse Rev II-Eligibility – Southeastern MA

Under the general supervision of the Associate Director, or designee, the Nurse Reviewer II is responsible for completing in-person assessments and reviewing medical records to determine clinical eligibility for individuals who are residing in a nursing facility, chronic disease, or rehabilitation hospital who would like to return to the community and receive supports and services through the ABI and MFP Home and Community Based Waivers. Additionally, the Nurse Reviewer II completes annual or interval in-person assessments by reviewing medical records, assessing community needs and risks, and provides resource support for program participants/applicants. This position ensures that eligible individuals can be safely served in accordance with relevant program/waiver guidelines and regulations.

Contribute as an active member of a multi/inter-disciplinary team to assess, plan, organize, review and evaluate clinical eligibility.

• Conduct on-site assessments of applicants’/participants’ medical, functional, psychosocial, and supportive needs to determine community, whether risks can be mitigated, and mitigation strategies within the terms of the ABI/MFP Waiver.

• 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 applicants’/participants’ holistic needs, without bias.

• Contact providers, state agency offices, and applicants/participants, and collateral support 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.

• 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 applicants/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 (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.

• 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

• Experience with disabled or long term care populations

• Experience in one of the following areas: Long-Term Care, Home Care, Rehab, Brain Injury, Mental Health, Substance Abuse and/or Disabilities.

Remote/desk work with statewide travel required