Position requires RN or LPN license for Louisiana. Also, must have MDS experience and ICD 10 coding. Pay depends on experience with sign-on bonus.
Do you have a passion for caring & helping others?
Join a team where we take pride in our mission statement, “Our Family Caring for your Family”.
Job Summary
The Nurse Case Manager (NCM) is responsible for the coordination between the Assessment Department and Interdisciplinary Team (IDT) including scheduling of the RAI process, preadmissions, admissions, nursing documentation and evaluations for continued stay. The NCM shall ensure an effective assessment program by complying with ethical standards when setting ARDs, completing assessments, and upholding Medicare/Medicaid requirements. The NCM is responsible for adequately assessing nursing facility residents’ needs using the Resident Assessment Instrument (RAI) process and for coordinating individualized resident centered care. The NCM coordinates with the Interdisciplinary Team to develop, revise, update, and maintain a comprehensive care plan and ensure that compliance is maintained with state and federal guidelines. Coordinates with the Billing Department to assign HIPPS payment categories and UB 04 coding. Develops and monitors on-going MDS schedules for each resident. The NCM assists with the coordination of care delivery by applying advanced nursing clinical skills, completing assessments, analyzing data, educating team members, and coordinating the exchange of resident information across care settings. The NCM works with hospice representatives to coordinate care to the hospice provided resident. Follows a flexible work schedule to cover weekend admissions. Performs general nursing duties as required. The Nurse Case Manager is responsible to the Director of Nursing (DON).
Education
Must be a Licensed Nurse, LPN or RN. Must be a graduate of an accredited school of nursing currently registered with the state agency for nursing licensure and certification and hold a valid license in the state he/she is employed.
Qualifications
1. At least 1 year experience with MDS’s RAI process and Medicare is preferred.
2. Demonstrates leadership and management ability.
3. Is capable of implementing changes as mandated by Federal, State and management requirements.
4. Is of good emotional, mental and physical health, having sound judgment and high professional standards.
5. Must be willing to be in the facility working with the staff of each shift if need arises.
6. Must be willing to be in and/or available to the facility week-ends as well as week days as needs arise.
7. Must demonstrate the ability to function as a cooperative team member with all disciplines in the facility.
8. Is willing and capable of providing emergency care as needed for any resident in the facility.
9. Experience in case management and rehabilitation nursing is preferred.
10. Must have integrity, attention to detail, accuracy, time-management skills, ability to meet deadlines, critical-thinking skills, written and verbal communication skills, care plan development skills, and problem solving skills
Responsibilities
This list is only partial and should not be interpreted as a comprehensive inventory of all duties, tasks, and responsibilities.
1. Knowledgeable of federal, state, and local government regulations and legislation.
2. Coordinate the RAI process, which includes, at a minimum: Minimum Data Set (MDS) Care Area Assessment process Care plan development Care plan implementation Evaluation
3. Provides oversight of assessment completion and transmission to the national repository. Review final validation reports and corrections or modifications in response to warnings or errors as needed
4. Oversees the baseline care plan and coordinate the completion of the comprehensive care plan according to regulatory requirements.
5. Maintains the MDS OBRA and PPS assessment schedules notifying the IDT of any changes
6. Determines skilled level of care for Medicare residents and procuring required Medicare-specific documentation; responsible for physician certification of a skilled level of care throughout the Medicare stay; involved in making eligibility determinations during the pre-admission and post-admission process.
7. Coordinates care with case managers for residents utilizing managed care, health maintenance organizations (HMOs), commercial insurance, and other alternate payment models
8. Maintains compliance with state-specific regulations regarding the RAI process and case mix requirements.
9. Provide insight and analysis of MDS-based Quality Measures
10. Serves as a member of the quality assessment and assurance (QAA) and the quality assurance and performance improvement (QAPI) committees as requested by the DON.
11. Works closely with hospital discharge planners and physicians to obtain accurate and complete documentation to support ICD-10-CM diagnosis coding and surgical procedures
12. Audits and improves staff education/competency as needed to ensure accurate and timely completion of supporting documentation and MDS assessments
13. Participates in discharge planning, training, caregiver training, and the provision of resources as needed
14. Maintains confidentiality of sensitive information
15. Plans, organizers, prioritizes, work independently, and meets deadlines
16. Works effectively with individuals at all levels of the organization, as well as with residents, family members, visitors, government personnel, and the public
17. Identifies cost variances and recommends cost controls related to resource utilization
18. Be knowledgeable of regulations, practice standards, and procedures, as well as laws, regulations, and guidelines pertaining to the RAI process.
19. Possess the ability to plan, organize, develop, implement, and interpret the programs, goals, objectives, policies and procedures, etc., that are necessary for ensuring the accurate and timely completion of the RAI documents
20. Ensure that the residents’ rights to fair and equal treatment, self-determination, individuality, privacy, property, and civil rights, including the right to file grievances are always well-established and maintained
21. Attends and communicates information to and from Daily Stand-Up Meeting, Admission Meetings, and Utilization Review Meetings.
22. Adjusts assignments of assessment department members when necessary (unbalanced workload). Adjusts assignments for absences, vacations, and vacant positions in assessment department.
23. Completes Requests for issuance for denial letters.
24. Demonstrates ability to directly perform treatments and provide services to the level of licensure.
25. Knowledge of medication and their correct administration based on age of the resident and their clinical condition.
26. Make rounds on all admissions and re-admissions from the hospital for 30 days from admission and observe for any new or escalating problems.
27. Serves as hospice care coordinator.
28. Reports immediately to supervisor, administrator and local law enforcement situations involving abuse, neglect, or suspicion of a crime.
29. Adheres to the Code of Conduct, Compliance Program, HIPAA Standard, and Computer Usage Agreement.
Requirements
1. Adheres to dress code, appearance is neat and clean.
2. Completes educational requirements per policy.
3. Maintains regulatory requirements.
4. Occasional travel/overnights required for training and professional meetings.
5. Reports to work on time and as scheduled. Completes work within designated time.
6. Wears identification while on duty.
7. Attends specified staff meetings, reads and returns all information required by immediate supervisor.
8. Completes work in designated time frames.
Pay: From $27.00 per hour
Benefits:
- 401(k)
- Dental insurance
- Disability insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Experience:
- MDS: 1 year (Required)
- Long term care: 1 year (Preferred)
- ICD coding: 1 year (Required)
License/Certification:
Work Location: In person
