Clinical Reviewer

DIVERSIFIED HUMAN SERVICES, INC.

A.D.A. Position Description

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POSITION TITLE:  Clinical Reviewer

REPORTS TO:  Director                                                                                   PROGRAM: Developmental Services

GRADE:  12

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OVERALL FUNCTION:

The Clinical Reviewer will use The Health Risk Screening Tool (HRST) to screen individuals by using the 22-rating system to detect health risks. You will be responsible for using the assessment tool to produce suggested action steps in the form of Service and Training considerations to inform supporters on how to respond to objectively identified risks. The HRST is designed to and intended to empower supporters with information needed to oversee the health and welfare of individuals more effectively.

ESSENTIAL FUNCTIONS: 

• Using the HRST you will be responsible for early detection of health risks and identify the actions of health risks to reduce and prevent health-related complications.
• Assist the provider in identifying additional services for the individual and training for the staff allowing the individual to be served more effectively.
• Educate and assist providers and families to have meaningful conversations with community physicians, clinicians, and other medical professionals.
• Perform a clinical review of the HRST at a minimum of once a year, however if changes in the individual’s health status, either deterioration or improvement additional screenings will need to be completed upon request.
• Responsible for keeping the HRST current for each individual who experiences changes that may affect the score of the 22 rating items.
• If individual’s HRST Health Care Level reaches a score of 3 or higher you will be responsible for updating the HRST of changes as soon as possible but no later than 14 days of those changes.
• Completes all required patient care documentation and other medical information, in an accurate and timely manner.
• Always maintain patient confidentiality.
• Adheres to all policies, laws, regulations and codes of ethics and confidentiality as outlined by federal and state laws, and agency policies and procedures.

EQUIPMENT UTILIZED:

The Clinical Reviewer utilizes a wide variety of durable medical equipment and supplies as required for the care of the homebound patient's nursing and personal care.

WORK ENVIRONMENT:

Normal office setting.

4/2023-DHS, INC., CLINICAL REVIEWER-ADA

REQUIRED QUALIFICATIONS:

A.   Knowledge, Skills, and General Abilities

• Bachelor of Science in Nursing or successful completion of a Registered Nurse program from an           accredited School of Nursing or Graduate of an approved Practical Nurse Program.
• Current and valid licensure to practice in the Commonwealth of Pennsylvania.

• Must complete HRST Online Rater and Clinical Reviewer training.

• Must successfully obtain Criminal History Clearance from the PA State Police, Child Abuse Clearance from the PA Department of Human Services and FBI Fingerprint Clearance.
• Must not be excluded from participation in Medicare, Medicaid or any other federal health care program.

B. Physical Abilities

• Ability to receive, understand and communicate information with effectiveness, and follow instructions.
• Ability to transport oneself to patient and regularly travel to various patients' homes and facilities; must have reliable transportation and automobile insurance.

C. Mental Abilities

• Ability to understand and carry out specific instructions.
• Maturity and ability to deal effectively with the stress of the position.
• Ability to receive performance feedback and instructions in a professional manner.

This Job Description has been designed in accordance with the provisions of the AMERICANS WITH DISABILITIES ACT.  It is intended to serve as a description of the essential function(s) for which this position exists and the required qualifications.  Individual tasks and procedures are not listed because they usually dictate the manner in which a function is performed rather than the purpose.  This Job Description shall be subject to such review and modification as determined necessary by the Agency.  Requests for reasonable accommodation, from a qualified individual with a disability, will be considered on a case-by-case basis.

I have reviewed this description and agree that it accurately reflects the job at this time.

Immediate Supervisor______________________________       Date____________________

Executive Director_________________________________       Date____________________

Personnel Director_________________________________      Date____________________

I have reviewed this description and received a copy of same.

Employee_________________________________________   Date____________________

Print Name________________________________________   Date____________________