Clinical Reviewer

Rogers Memorial Hospital•Oconomowoc, WI

About The Position

The Clinical Reviewer receives and reviews prospective patient screening materials (to include admissions screening interview [ASI] and various internal or external records), delivers clinical/programmatic recommendations to department and division team members, collaborates with providers and performs other duties as directed by their supervisors.

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).

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.
Conduct self in a professional manner.
Demonstrate organizational skills that promote timely responses.
Communicate with all individuals in a positive and professional manner.
Identify concerns and provide input for resolution.
Use solution-focused mindset in situations to resolve individual issues with peers in a positive and calm manner.
Promote positive team-oriented approach to patient access.
Maintain a supportive and collaborative environment with all disciplines.
Demonstrate a positive and professional attitude toward parties outside the facility (patients, families, visitors, vendors, etc.)
Use courteous, cooperative, and respectful behavior when working with patients, families, physicians, visitors, and employees.
Display leadership and positive role-modeling.
Project a professional image in attire, grooming, and presentation.
Display professionalism in all aspects of the position.
Arrive on time, prepared for work responsibilities.
Adhere to Code of Ethics, Code of Conduct, maintain confidentiality, and abide by professional license code of ethics.
Support changes in staffing/scheduling as department and division needs require.
Accept reassignment in a positive manner.
Demonstrate willingness to adjust work schedule to meet departmental and divisional needs.
Recognize need for support, seek appropriate assistance when needed, continually remain alert to peers who need assistance, and offer assistance when needed.
Apply good practice principles to job duties.
Complete orientation, annual competencies, educational requirements, and required training relevant to the position.
Provide appropriate, timely documentation in the patient medical record.
Attend and participate in staff meetings, group and individual supervision meetings, and in-services relevant to position.
Participate in projects, tasks, and opportunities to improve skills and expand competency.
Comply with the organization’s policies and procedures.
Adhere to all established standards of practice.
Participate in on-call rotation if applicable.
Demonstrate acceptance and training of students/interns in the department as requested.
Promote Mission and goals of the organization.
Perform other duties as assigned.
Participate in site committees.
Be punctual and prepared.
Demonstrate effective communication skills and good organization skills.
Actively participate in discussions, recognize, and contribute to activities leading to improvement.
Rogers Operating System (ROS). Gain understanding of the ROS and MDI process.
Participate in the ROS program on an ongoing basis.
Create and apply ROS projects that lead to improvement.
Apply the ROS model to your department’s activities.
Demonstrate measurable goals and achievement.
Participate in daily huddles with team(s) assigned.
Demonstrate understanding of Joint Commission, State, and other regulatory agency compliance regulations.
Be knowledgeable in the application of standards relevant to outpatient behavioral health program.
Increase knowledge and awareness of regulations and involve self in educating others.
Provide for patient safety and the safety of the facility.
Intervene appropriately to maintain patient safety.
Communicate any patient safety concerns to the Patient Access and/or Admissions Leadership and Senior Clinical Director.
Report any safety hazards promptly to the Senior Clinical Director.
Document safety incidents via the incident reporting portal.
Adhere to all System guidelines for safety.
Follow emergency protocols.