Clinical Reviewer PASRR - (PRN) - Hybrid role in Tallahassee, Florida

Following a 2022 merger of CNSI and Kepro, Acentra Health combines clinical services, technology solutions, and data analytics to accelerate better health outcomes. This is a great time to join our team of passionate individuals working together to pursue the most effective solutions to today’s complex healthcare challenges. Our culture is fueled by passion and driven by purpose.

Position Summary

The Clinical Reviewer is integral to our team, conducting Preadmission Screening and Resident Review (PASRR) assessments for individuals who require nursing facility-level services due to serious mental illness, intellectual disabilities, or related conditions. In this vital role, you will engage in holistic, person-centered evaluations, which encompass a detailed analysis of medical and behavioral health records, comprehensive assessments, and active collaboration with the treatment team.

As a Clinical Reviewer, your expert analysis will confirm diagnoses and enable you to formulate nuanced care recommendations. These recommendations will ensure that individuals receive the specialized services they need, all within carefully integrated settings designed to support their health and well-being.

This is a (PRN) hybrid role that will entail working from your home office while also dedicating a portion of your day to fieldwork, involving travel to patients within your surrounding counties and in proximity to your residence. Must be open to covering the Redding area. All required travel expenses, including mileage and gas, will be fully reimbursed. Embracing this hybrid position offers the best of both worlds.

Job Responsibilities

• Conduct detailed and personalized assessments using PASRR Level I screenings and Level II evaluations to make informed, person-centered determinations.
• Deliver timely and precise clinical assessments by reviewing pertinent records, consulting with our treatment teams, and conducting interviews with collateral sources and our Medical Director.
• Thoroughly verify eligibility for services by assessing whether individuals meet the criteria for Serious Mental Illness (SMI), Intellectual Disability, or Other Related Conditions (ID/RC) according to federal, state, and contractual guidelines.
• Accurately complete PASRR reviews, determining the appropriate level of care needed based on a comprehensive evaluation of the patient’s physical, behavioral, and psychological well-being, along with their medical, behavioral health, and social histories.
• Maintain strict adherence to mandated workflow timelines, including conducting re-reviews of records as required by the Clinical Director, Quality Manager, or Medical Director.
• Engage actively in staff meetings and contribute to case consultations, peer reviews, and internal audits as necessary.
• Continuously update your knowledge by reviewing current literature, regulations, and research related to long-term care, mental health, intellectual disabilities, medical conditions, and geriatrics.

Required Qualifications, Skills, Knowledge, and Experience

• A minimum of three years' experience in assessing and diagnosing mental/psychiatric disorders, including complex differential diagnoses related to substance use, medical conditions, cognitive issues, and dementia.
• At least one year of experience working with individuals with intellectual disabilities or related conditions.
• Credentials as a Registered Nurse, Licensed Clinical Social Worker, Licensed Clinical Psychologist, Nurse Practitioner, or other qualified Mental Health Professional and Qualified Intellectual Disability Professional, with licensure in the state of Florida.
• A degree from an accredited college in a relevant program.
• Comprehensive knowledge of psychiatric disorders as defined by the most current Diagnostic and Statistical Manual utilized in Florida.
• Highly skilled in clinical diagnosis, with a specialized focus on psychological and behavioral issues.
• Proficient in utilizing computer equipment and leveraging web-based software for professional applications
• Ability to interact effectively with office staff to support workflow requirements.
• Understanding of standards of practice for determining Level of Care, as well as standards related to mental health, intellectual and developmental disabilities, geriatrics, and other conditions often requiring long-term care services and supports.
• Skilled and proficient in evaluating psychological, emotional, behavioral, and physical functioning, adept at crafting tailored level of care recommendations based on comprehensive clinical assessments.
• Working knowledge with Federal Regulation 42 CFR, Chapter 483.
• Familiarity with public sector services and supports/
• Strong interpersonal