OBRA PASRR Evaluator (Contingent)

Job description

OBRA PASRR Evaluator (Contingent)
(THIS IS A CONTINGENT POSITION)
INCUMBENTS WILL BE PAID PER ASSESSMENT

Under the general supervision of the Director of Integrated Care, the OBRA/PASRR Evaluator will determine if qualifying Pre-Admission Screening Resident Reviews (PASRR) conditions are present and if a nursing home is the appropriate level of care based on individual needs.


PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Determines if qualifying Pre-Admission Screening Resident Reviews (PASRR) conditions are present.
• Determines if a nursing home is the appropriate level of care based on individual needs.
• Provides outreach mental health assessments pursuant to PASRR regulations.
• Conducts multidisciplinary assessments which includes a diagnostic formulation, disposition and treatment recommendations.
• Verifies the presence of a disability and determines if a nursing facility is the most appropriate care setting or if the individual has a need for specialized services.
• Uses client’s social history, medical reports, patient care, plan of treatment, current physician’s orders, current medications and ongoing therapy reports to make the determination.
• Gathers data pertinent to a client’s functioning and history.
• Conducts evaluations prior to nursing facility admissions.
• Contacts providers, nursing facility staff and others to obtain information and records of clients to conduct a comprehensive clinical review of the case and to make final determinations.
• Creates or validates the appropriate treatment plan.
• Makes determinations and service recommendations, authorizes services and monitors service plans.
• Submits formal recommendations and reports that contain clinical summaries.
• Determines medical necessity and the need for specialized services for individuals with serious mental illnesses seeking transfer to nursing facilities.
• Documents significant changes that signify the need for an updated evaluation.
• Completes evaluations on an individualized basis in accordance with federal guidelines and regulations.
• Provides provisional diagnosis formulation, disposition and treatment recommendations.
• Assures that dispositions and treatment recommendations are consistent with the data base.
• Communicates all evaluation findings to clients and guardians.
• Responds to Level II referral assignments within contract guidelines as evidenced by submission of all assessments within 7 days of assignments.
• Performs related duties as assigned.

KNOWLEDGE, SKILLS, AND ABILITIES (KSA’s):
• Knowledge of DWIHN policies, procedures and practices.
• Knowledge of the DWIHN provider network and community resources.
• Knowledge of the Michigan Mental Health Code.
• Knowledge of MDHHS policies, rules, regulations and procedures.
• Knowledge of Federal policies, rules, regulations and procedures as it relates to DWIHN.
• Knowledge of behavioral health and mental health principles and practices.
• Knowledge of the Michigan Medicaid Provider Manual.
• Knowledge of MHWIN.
• Knowledge of and ability to use screening and assessment tools for behavioral health services.
• Knowledge of Medical Necessity Criteria for Behavioral Health Services.
• Knowledge of the American Society of Addiction Medicine Patient Placement Criteria.
• Knowledge of Integrated Care principles and practices.
• Knowledge of the Omnibus Budget Reconciliation Act (formerly known as the Nursing Home Reform Act of 1987) (OBRA) rules, regulations and requirements.
• Knowledge of Pre-Admission Screening and Resident Review (PASRR) guidelines.
• Knowledge of the 3877/3878 database.
• Knowledge of mental health as it relates to the aging population.
• Knowledge of nursing home practices and procedures.
• Knowledge of Level 1 and Level II Assessments based on the MDHHS PA