OT or PT
OT or PT - Allied Health Clinical Reviewer II
GENERAL SUMMARY OF POSITION: The Clinical Reviewer II under the general supervision of the Associate Director or their designee is responsible for the authorization, coordination and facilitation of health care services for program applicants and participants. As a member of a multi inter-disciplinary team this position is responsible for assessing planning organizing reviewing and evaluating the care needs of applicants participants requiring heath care services. This position ensures that clinically eligible individuals are referred to appropriate services based on medical necessity determinations and program regulations. MAJOR RESPONSIBILITIES: Act as an active member of a multi/inter-disciplinary team Conduct on-site intake and reassessments to determine clinical eligibility and medical necessity for assigned program and health care services Determine and authorize services for applicants/participants in accordance with program guidelines and regulations Conduct routine and ad hoc reviews and re-evaluations of applicants/participants services Travels statewide to applicant/participant homes and service providers places of business Reviews and data enters applicant/participant information and service authorizations in relevant information system applications in accordance with program guidelines and regulations Requests medical/clinical records from treating sources in writing by telephone or by fax. Maintain individual records documenting all applicant/participant encounters and contacts; writes 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 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 and state agencies Maintain the confidentiality of all business documents and correspondence. 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. REQUIRED QUALIFICATIONS: RN licensed to practice in Massachusetts Masters prepared vocational rehabilitation counselor or other Allied Health professional strongly preferred in one or more of the following specialty areas: acute medicine long term care mental health disabilities occupational therapy physical therapy rehabilitation social work or equivalent 5-10 years work experience 3-5 years related work experience providing direct service or case management Experience with program related services/populations preferred. Experience with Word and Excel and other desktop tools. If interested, please apply online at http://track.tmpservice.com/A pplyClick.aspx?id=1411174-2245-223 .