OBRA PASRR Evaluator

Company: Detroit Wayne Integrated Health Network
Location: Detroit
Posted on: June 4, 2025

Job Description:

Under the general supervision of the Director of Integrated Care, the OBRA/PASRR Evaluator will determine if qualifying Pre-Admission Screening Resident Reviews (PASRR) conditions are present and if a nursing home is the appropriate level of care based on individual needs. PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Determines if qualifying Pre-Admission Screening Resident Reviews (PASRR) conditions are present.
• Determines if a nursing home is the appropriate level of care based on individual needs.
• Provides outreach mental health assessments pursuant to PASRR regulations.
• Conducts multidisciplinary assessments which includes a diagnostic formulation, disposition and treatment recommendations.
• Verifies the presence of a disability and determines if a nursing facility is the most appropriate care setting or if the individual has a need for specialized services.
• Uses client's social history, medical reports, patient care, plan of treatment, current physician's orders, current medications and ongoing therapy reports to make the determination.
• Gathers data pertinent to a client's functioning and history.
• Conducts evaluations prior to nursing facility admissions.
• Contacts providers, nursing facility staff and others to obtain information and records of clients to conduct a comprehensive clinical review of the case and to make final determinations.
• Creates or validates the appropriate treatment plan.
  • Makes determinations and service recommendations, authorizes services and monitors service plans.
  • Submits formal recommendations and reports that contain clinical summaries.
  • Determines medical necessity and the need for specialized services for individuals with serious mental illnesses seeking transfer to nursing facilities.
  • Documents significant changes that signify the need for an updated evaluation.
  • Completes evaluations on an individualized basis in accordance with federal guidelines and regulations.
  • Provides provisional diagnosis formulation, disposition and treatment recommendations.
  • Assures that dispositions and treatment recommendations are consistent with the data base.
  • Communicates all evaluation findings to clients and guardians.
  • Responds to Level II referral assignments within contract guidelines as evidenced by submission of all assessments within 7 days of assignments.
  • Responds to clinical matters as directed by Supervisors.
  • Attends clinical meetings as scheduled by Supervisors.
  • Maintains individual records, HIPAA regulations and client confidentiality.
  • Performs related duties as assigned. KNOWLEDGE, SKILLS, AND ABILITIES (KSA's):
  • Knowledge of DWIHN policies, procedures and practices.
  • Knowledge of the DWIHN provider network and community resources.
  • Knowledge of the Michigan Mental Health Code.
  • Knowledge of MDHHS policies, rules, regulations and procedures.
  • Knowledge of Federal policies, rules, regulations and procedures as it relates to DWIHN.
  • Knowledge of behavioral health and mental health principles and practices.
  • Knowledge of the Michigan Medicaid Provider Manual.
  • Knowledge of MHWIN.
  • Knowledge of and ability to use screening and assessment tools for behavioral health services.
  • Knowledge of Medical Necessity Criteria for Behavioral Health Services.
  • Knowledge of the American Society of Addiction Medicine Patient Placement Criteria.
  • Knowledge of Integrated Care principles and practices.
  • Knowledge of the Omnibus Budget Reconciliation Act (formerly known as the Nursing Home Reform Act of 1987) (OBRA) rules, regulations and requirements.
  • Knowledge of Pre-Admission Screening and Resident Review (PASRR) guidelines.
  • Knowledge of the 3877/3878 database.
  • Knowledge of mental health as it relates to the aging population.
  • Knowledge of nursing home practices and procedures.
  • Knowledge of Level 1 and Level II Assessments based on the MDHHS PASRR Operation Manual Guidelines for completing a comprehensive Level II evaluation.
    • Knowledge of the Diagnostic Formulation of Level II Assessments based on the DSM criteria.
    • Knowledge of diagnostic formulation, disposition and treatment recommendations.
    • Knowledge of ICD 9, CPT Codes, DSM-IV Statistical Manual or most current diagnostic edition.
      • Knowledge and understanding of mental diagnoses, behaviors and/or prescribed medications.
      • Knowledge of developmental issues in the older adult population.
      • Knowledge of how mental illness impacts older adults.
      • Computer skills (Word, Excel, Access, Power Point, Outlook, Teams).
      • Diagnostic skills.
      • Assessment skills.
      • Evaluation skills.
      • Organizational skills.
      • Planning skills.
      • Reasoning skills.
      • Problem Solving skills.
      • .
      • Implementation skills.
      • Written communication skills.
      • Accuracy and detailed oriented skills.
      • .
      • Relationship-building skills.
      • Ability to communicate orally.
      • Ability to communicate in writing.
      • Ability to work effectively with others.
      • Ability to work with an ethnically, linguistically, culturally, economically and socially diverse population.
      • Judgement/Reasoning ability. REQUIRED EDUCATION:A Master's Degree in Social Work, Psychology, Counseling, Nursing (a Bachelor's Degree will be accepted), the Human Services, the Social Services or a related field. REQUIRED EXPERIENCE:Three (3) years of full-time paid professional experience working in a human service, social service, mental health or behavioral health setting.ANDOne (1) year of full-time paid professional experience performing clinical assessments, clinical diagnosis, case management or related duties and responsibilities in a human service, social service, mental health or behavioral health setting. OBRA/PASSR experience is preferred. REQUIRED LICENSE(S):A Valid State of Michigan clinical licensure: RN, LMSW, LMHC, LPC, LLP or PhD. (A limited license will be accepted). A Valid State of Michigan Driver's License with a safe and acceptable driving record. WORKING CONDITIONS:Work is usually performed in an office setting but requires the employee to drive to different sites throughout Wayne County and the State of Michigan. This position can work remotely with supervisory approval. Currently this position is primarily a remote position. This description is not intended to be a complete statement of job content, rather to act as the essential functions performed. Management retains the discretion to add or change the position at any time. Please Note: DWIHN requires proof of being fully vaccinated for COVID-19 as a condition of employment. Medical or religious accommodations or other exemptions that may be required by law, will be approved when properly supported. Further information will be provided during the recruitment process. The Detroit Wayne Integrated Health Network is an Equal Opportunity Employer
        

Keywords: Detroit Wayne Integrated Health Network, Canton , OBRA PASRR Evaluator, Other , Detroit, Michigan