State of Massachusetts Office of Long Term Services and Supports, Nurse Reviewer in Tewksbury, Massachusetts
Duties and Responsibilities (these duties are a general summary and not all inclusive):
The Nurse Reviewer will be responsible for conductingad-hoc investigation in response to complaint regarding MMQ and other clinical audits conducted by the Long Term Services and Supports (LTSS) Third Party Administrator (TPA).This position will be located in the Tewksbury office.
Provide Clinical Program expertise to the OLTSS provider community including:
· Training and technical assistance for stakeholders including OLTSS and healthcare providers around evidence-based and best practices and program clinical criteria.
· Participating in OLTSS quality improvement and performance measurement activities including but not limited to provider chart reviews.
· Helping providers evaluate and address complex clinical situations/cases.
· Serve as a resource to Program Managers for clinical issues.
· Ad-hoc clinical surveys and audits.
· Ad-hoc assessment to identify individuals for appropriateness of service level of care including conducting clinical eligibility reviews.
· Conduct relocation activities and act as a liaison in nursing facility closures.
· Participate in development of alternative models of patient classification systems.
Participate in OLTSS Program Audits:
· Serve as clinical reviewers for the clinical oversight of the TPA for all the programs.
· Conduct ad-hoc reviews for emergency NF closures.
· Conduct clinical reviews for OLTSS community programs.
· Assess for and identify health indicators important for access and services for the population.
· Conduct other ad-hoc clinical program reviews.
Participate in Program Integrity:
· Participating in the oversight activities of the TPA.
· Ad-hoc program reviews as needed to support the programs.
Provide ad-hoc support to SCO and PACE Clinical Staff. This includes:
· Review of SCO and PACE assessments.
· SCO program reviews.
· PACE program reviews.
Complete periodic statewide nursing facility census and utilization reports.
Other ad-hoc clinical tasks to support OLTSS:
· Participate in MMQ and other NF related training for TPA field nurses.
· PASRR Level review and verification of presence of level 2 when appropriate.
· Other duties as assigned.
Knowledge of nursing principles and standards;
Knowledge of Geriatric and disability nursing;
Knowledge of long term care regulations, standards and practices and guidelines governing agency operation and assigned unit function;
Knowledge of MDS and Knowledge of MMQ;
Ability to maintain accurate records;
Ability to follow written and oral instructions;
Ability to communicate both verbally and in writing information in a manner which is precise and understandable;
Ability to establish and maintain harmonious working relationships with others.
Please upload both Resume and Cover Letter for this position when applying. First consideration will be given to those applicants that apply within the first 14 days.
MassHealth, the Commonwealth’s Medicaid program, provides health care benefits to certain low and medium-income Massachusetts residents. As an innovative national leader, the Commonwealth’s Medicaid program offers the opportunity to work with state-of-the-art technologies in a cutting-edge, fast-paced, call center environment. Selected applicants will have exceptional customer service, communications, and analytical skills. We offer a unique opportunity to serve, and to make a positive contribution to our members.
The mission of MassHealth is to improve the health outcomes of our diverse members, their families and their communities by providing access to integrated health care services that sustainably promote health, well-being, independence and quality of life.
For more information about our agency and programs please visit: www.mass.gov/masshealth
As an employee of the Commonwealth of Massachusetts you are offered a great career opportunity influencing a wide-spectrum of services to the diverse populations we serve - but it's more than a paycheck. The State's total compensation package features an outstanding set of employee benefits which you should consider towards your overall compensation, including:
75% state paid medical insurance premium
Reasonable Dental and Vision Plans
Flexible Spending Account and Dependent Care Assistance programs.
Low cost basic and optional life insurance.
Retirement Savings: State Employees' Pension and a Deferred Compensation 457(b) plan.
11 paid holidays per year and competitive Sick, Vacation and Personal Time.
Tuition Benefit for employee and spouse at state colleges and universities
Short-Term Disability and Extended Illness program participation options
A criminal background check will be completed on the recommended candidate as required by the regulations set forth by the Executive Office of Health and Human Services prior to the candidate being hired. For more information, please visit
http://www.mass.gov/hhs/cori and click on "Information for Job Applicants."**
Education, licensure and certifications will be verified in accordance with the Human Resources Division’s Hiring Guidelines
Education and license/certification information provided by the selected candidate(s) is subject to the Massachusetts Public Records Law and may be published on the Commonwealth’s website.
For questions, please the contact the Executive Office of Health and Human Services Human Resources at 1-800-510-4122 and select option #2.
First consideration will be given to those applicants that apply within the first 14 days.
MINIMUM ENTRANCE REQUIREMENTS:
Applicants must have at least (A) one year of full-time or equivalent part-time, experience as a registered nurse in a recognized hospital, clinic or medical facility, and (B) six months of which must have been in a supervisory, administrative or managerial capacity.
SPECIAL REQUIREMENTS FOR ALL LEVELS IN SERIES: Current and valid registration as a professional nurse under the Massachusetts Board of Registration in Nursing.*
*Recent graduates from an approved school of nursing must have applied for the first available registered nurse examination.
Based on assignment, possession of a current and valid Massachusetts Motor Vehicle Operator's license may be required.
An Equal Opportunity / Affirmative Action Employer. Females, minorities, veterans, and persons with disabilities are strongly encouraged to apply.
Job: *Medical Services
Organization: *Exec Office Of Health and Human Services
Title: Office of Long Term Services and Supports, Nurse Reviewer
Location: Massachusetts-Tewksbury-367 East Street
Requisition ID: 200007HP