Clinical Reviewer

Job Duties & Responsibilities:

Provide clinical/programmatic recommendations based on guidance issued by Rogers Medical Directors, and Associate Medical Directors for prospective patients and their families/significant others.

• Review and evaluate completed admission screenings to provide a recommendation on appropriate program, level of care, and (if appropriate) mode of delivery for prospective patient.
• Review materials to include admissions screening interview (ASI), transfer documentation (TRF/TCF), external provider documentation, charted history from prior Rogers treatment encounters, external treatment summaries, test reports, or letters from interested others.
• Review and demonstrate an understanding of the various treatment programs offered at Rogers, as well as their basic inclusion and exclusion criteria.
• Review and demonstrate an understanding of the levels of care provided at Rogers, as well as basic metrics used to determine when each is considered appropriate or necessary for a given patient presentation.
• Review and demonstrate an understanding of the various modes of treatment delivery available at Rogers, as well as of the latest organizational guidance regarding when each is considered appropriate or necessary for a given patient presentation.
• Interact with team members, external providers and referents in a respectful manner reflecting positively upon the organization at all times.
• Adhere to materials provided to ensure clinical accuracy and consistency. Convey recommendations and suggestions in a manner that facilitates managing patient/family expectations related to services provided. If necessary, promptly initiate contact with referring providers or treatment teams to determine accurate clinical/programmatic recommendation for patients.
• Provide clear guidance to team on clinical reasoning of recommendation and/or justification for level of care for most accurate relay to patients/families.
• Document progress using the visual tracking/management system provided.
• Attend all pertinent MDI huddles as directed by medical/clinical and admission Leader.
• Complete reviews/recommendations and all required supporting work and documentation in a timely manner in order to ensure quality prospective patient experience.
  

Facilitate report and documentation of suspected cases of physical, sexual abuse and/or neglect according to applicable state laws and according to System policy and procedure.

• Implement understanding of the System policies and procedures.
• Implement understanding of the Mandatory Reporting state laws across all RBH locations/states.
  

Provide leadership and guidance in the delivery of clinical recommendations.

• Evaluate the outcome of departmental and divisional initiatives and assist with modification of the review and recommendation processes accordingly.
• Assist with the development and evaluation of the processes and modalities used to complete the review process.
• Participate and/or facilitate interdisciplinary meetings for process planning, updating and progress monitoring.
  

Communicate professionally and accurately.

• Refer to and work with other departments and agencies as needed and according to departmental policies.
• Report pertinent data to the attending provider and others on the team, verbally or in writing as necessary, and prioritize effectively and consistently in situations requiring immediate attention versus postponement.
• Immediately communicate difficult problems with referents, patients, family members/significant others and co-workers.
• Ask for supervision to assist with problem resolution, when appropriate.
• Attend and participate in all department meetings and provide feedback concerning departmental issues.
• Develop and maintain relationships with medical staff and other providers across RBH for ongoing re-review or other case communication.
  

Demonstrate strong interdisciplinary approach, facilitating effective communication among departments.

• Display a positive attitude and participate as a team member.
• Provide support and education as requested by supervisors to Patient Access and Admissions teams for growth and development of team members and to improve review process and understanding.
• Communicate in a respectful and assertive manner to team members and other System personnel.
• Adhere to organizational philosophy.
  

Additional Job Description:

Education/Training Requirements:

• Master's Degree in Psychology, Nursing, Social Work, or related field, from an accredited school of Social Work, Professional Counseling, or Family Therapy with a minimum of two (2) years' experience in health care and at least two (2) years in a psychiatric setting, preferred.
• Full, independent licensure as a Registered Nurse, Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT), Licensed Clinical Social Worker (LCSW) or equivalent in state practicing, i.e., LPCC, LMHC.
• Previous admitting triage experience required.
• Attend all mandatory in-services and other in-services relevant to the position. Be responsible for all educational requirements and related obligations pertaining to the license of the program/unit license regulatory requirements governing the program(s).

With a career at Rogers, you can look forward to a Total Rewards package of benefits, including:

• Health, dental, and vision insurance coverage for you and your family
• 401(k) retirement plan
• Employee share program
• Life/disability insurance
• Flex spending accounts
• Tuition reimbursement
• Health and wellness program
• Employee assistance program (EAP)

Through UnitedHealthcare, UMR and HealthSCOPE Benefits creates and publishes the Machine-Readable Files on behalf of Rogers Behavioral Health. To link to the Machine-Readable Files, please visit Transparency in Coverage (uhc.com)