Job Summary/Objective:
Conduct and/or manage the assessment processes for establishing Plans of Care for each Skilled Nursing and Long-Term Care (LTC) resident; interpret and implement Centers for Medicare and Medicaid Services (CMS) regulations assuring the highest quality of resident services and comprehensive and accurate billing for services are achieved.
Supervisory Responsibilities:
Oversees the daily workflow of the department.
Essential Functions/Duties/Responsibilities:
- Utilize the current RAI Manual as a resource during the assessment coding process.
- Gathers information on current residents for current and future assessments, including physical and mental states by assessing charts and communicating with health care team members to create applicable health care plans.
- Schedule the Assessment Reference Dates (ARDs) for payment assessments in a manner that accurately captures each resident’s clinical characteristics for payment classification maximization purposes.
- Schedule the ARDs for all Omnibus Budget Reconciliation Act (OBRA) assessments daily, monthly, and as needed.
- Provide a schedule of ARDs and assessment types weekly and as needed to the interdisciplinary team (IDT) in order to facilitate the timely completion of MDS sections and Care Area Assessments (CAAs) by each discipline.
- Communicate with members of the IDT, as needed, for timely completion of assessments. Report any issues with timeliness to the Administrator.
- Transmit assessments in accordance with current regulations. Facilitate timely receipt of validation reports. Transmit as frequently (daily) as necessary to obtain timely validation of MDS acceptance into the Quality Improvement and Evaluation System (QIES) Assessment Submission and Processing (ASAP) System database.
- Confirm transmission files by review and print initial and final validation reports.
- Correct any fatal errors immediately and retransmit the assessment until an accepted validation report is received.
- Facilitate the completion and update of resident care plans with the IDT to reflect each resident’s current needs.
- Attend resident care conferences, as applicable.
- Communicate with the IDT to identify residents in need of a Significant Change in Status assessment, based on criteria in the current RAI manual.
- Participate in all resource utilization and/or triple check meetings prior to billing claims associated with payment assessments.
- Participate in the admission process of prospective residents in terms of their nursing needs and appropriate placement by reviewing clinical referrals for high-cost medications, inappropriate behaviors, antipsychotic usage, clinical needs and rehabilitation potential.
- Review all Casper reports and reconcile Montereau quality indicators with national service trends, by investigating gaps and initiating solutions for service delivery with any/all Montereau service areas to lead quality improvement and quality assurance initiatives relating to MDS. Provide direct feedback and/or training to care givers or supervisors to enhance the quality of services to the residents and reimbursements to Montereau.
- Attend or participate in continuing education related to the RAI process and related programs to ensure knowledge of guidelines and regulations are always current.
- Complete all assigned training and skills competencies, as determined by the community assessment and facility training plans.
- Participate in the Nurse Manager On-Call rotation to support Nurse Care Partners with critical care decisions and ensure adequate staffing and scheduling.
- Work care base shifts, as needed, to ensure proper resident care is provided.
- Participate in the Leader On Duty (LOC) rotation.
- Performs administrative duties as assigned, including but not limited to QAPI, SOC, and participation in department or committee meetings.
- Participates in Caring Partner Rounds.
- Perform other related functions as required or as assigned.
Required Skills/Abilities/Competencies:
- Proficient knowledge of ICD coding and billing.
- Strong knowledge related to establishing and following care plans.
- Ability to work a variety of shifts (days, evenings, nights, weekends), when needed.
- Strong verbal and written communication skills, to effectively and empathetically address critical health and death issues with a diverse resident population and family members.
- Strong interpersonal and customer service skills.
- Excellent organizational skills, attention to detail, time management skills with a proven ability to meet deadlines and prioritize tasks appropriately.
- Ability to effectively manage sensitive and confidential communications and information, while maintaining a high level of poise, tact, and diplomacy.
- Strong analytical and problem-solving skills.
- Ability to function well in a high-paced and at times stressful environment.
- Ability to effectively interact with a diverse leadership team, team members, residents, family members and third-party associates including vendors, providers, and visitors.
- Proficient with Microsoft Office Suite or related software and PCC EHR.
Education and Experience:
A minimum of 3 years’ experience as a Licensed Practical Nurse or Registered Nurse working in a leadership capacity within a LTC facility that is Medicare or Medicaid certified using CMS service billing systems is required.
Previous quality assurance/quality improvement experience is preferred.
Current State of Oklahoma Registered Nurse license, or a Licensed Practical Nurse license who is working to obtain Registered Nurse license, is required.
Resident Assessment Coordinator Certification (RAC-CT) is required, or must receive certification within 1 year.
Current CPR and First Aid certification is required.
Physical Requirements:
An extensive amount of walking, standing, and sitting, with a moderate amount of bending at the waist, kneeling, twisting/turning, reaching above the head and shoulders, and eye-hand coordination.
Ability to routinely lift 35 pounds and push wheelchairs with loads of up to 300 pounds.
Frequent use of ordinary communication, including normal levels of hearing and vision, including both near and far seeing, color discrimination, field of vision, and depth perception.
Ability to use a computer or other office equipment for an extensive period of time.
Ability to occasionally travel by car and/or commercial airline.
Other Duties:
Please note this job description is not designed to cover or contain a comprehensive list of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights (https://www.eeoc.gov/poster) notice from the Department of Labor.
