What are the responsibilities and job description for the Corporate Operations - RN MDS position at Pioneer Health Care Management Inc?
Position Summary:
The Corporate MDS Coordinator is responsible for assigned facilities overseeing the (RAI) process in accordance with all laws, regulations, and standards to ensure accurate and timely completion of all required reporting/documentation of all components of the RAI process.
Core Responsibilities:
Monitors and ensures the timely scheduling, completion, and transmission of Minimum Data Set (MDS) assessments for all residents within the organization
Ensures that MDS staff utilize medical records, resident observation, resident interview, family and caregiver interviews, as well as the electronic record to assess residents and then document physical assessments, interviews, observations and review of the medical record for each resident accurately to determine appropriate diagnosis coding and enter codes into software
Check to make sure that daily meetings occur at each building with facility rehabilitation coordinator to review minutes, ICD10 diagnosis coding, activities of daily living (ADL) scores, and to track change of therapy (COT) needs as well as end of therapy (EOT) needs for PPS assessments
Participates on a rotating basis at each building in the PPS/Medicare meetings
Act as a resource to determine potential HIPPS codes and expenses associated with a potential admission
Develops monitoring systems to ensure compliance with:
MDS staff at each building coordinates, identifies, and/or initiates significant change in MDS
Maintaining the schedule of required Omnibus Budget Reconciliation Act (OBRA) and Prospective Payment System (PPS) assessments and communicate with IDT
Work with IDT to plan resident discharges from admission through discharge
Review hospital discharge summary to assist with appropriate diagnosis coding
Complete diagnosis listings, sheets, and modify diagnosis codes in relation to changes for residents
Determine, along with IDT team, what the reason for skilled services will be and coordinate care with IDT team to assure providing these skilled services
Assure that care plan dates are scheduled according to regulated guidelines at each facility
State Specific: case mix index (CMI), level of care determination (LOCD), tracking tools, Part B logs are completed monthly
Complete all Care Area Assessment (CAA) that trigger and facilitate development of care plans that coordinate with CAA assessments and MDS assessments
Keep under observation for each facility that a skilled stay for residents following Medicare and Insurance guidelines and contract provisions for Managed Care Part B and C residents, and Dual eligible skilled Medicaid residents as well as private insurance
Monitor the Review Triple Checks for A/R billing accuracy components weekly and monthly to assure compliance with skilled services regulations and contract stipulations
The referring of findings of inaccurate, untimely, or incomplete documentation to the Director of Nursing or Administrator and follow through to ensure timely compliance.
Ensures each facilitate conducts:
the weekly utilization review of patients on skilled services for Medicare A, and insurance patients
team meetings and support for RAI components, Medicare certification components, diagnosis coding components, and other areas as needed
Conducts meetings to determine changes in resident status to facilitate scheduling of required assessments, to include significant change assessments
Ensures MDS exception reviews per each individual state guidelines, coordinate RAI component
Develops and implements a system for identifying and communicating clinical QM flags on an ongoing basis
Responds to facility MDS staff as the contact for insurance updates/questions
Identify and communicate quality concerns identified at facilities,
Utilize software for completion of RAI components excluding section V, X, and Z; if RN will complete all sections
Utilize software to transmit assessments
Assure accurate completion of MDS exception of requirement of RN signature – if LPN
Support Interdisciplinary Team (IDT) Team to schedule and complete care plan reviews
Acts as a resource and supports the ADR process and medical records as needed
Monthly reviews the billing process with Business Office Management (BOM) to assure all required components are accurately reflected on UB-04 for each resident
Completes designated organizational reports and present MDS related operations/information at assigned leadership calls/meetings
For each assigned facility - monitor Case Mix Index (CMI) scores, looking for potential risks and/or changes that may affect Medicaid reimbursement
Assure access and logins for staff at each facility needed to gather and complete required components
Monitor Five Star Rating System: QM’s and how to access and read reports for each building within the organization
Support facility team in management of QM’s
Minimum Qualifications:
Minimum two (2) year long term care experience required.
Computer literacy skills including basic mouse and keyboard operations. Electronic clinical documentation experience preferred.
Experience as an MDS Nurse required
Demonstrates knowledge and experience with level of care determinations.
Excellent leadership skills
Strong organization skills
Ability to relate professionally to all customers
Ability to effectively communicate both orally and written form
Must be able to work independently, self-motivated and goal oriented
Ability to manage stress due to time constraints, responsibilities, emergencies, and interpersonal job demands.
Current BLS certification required.
Education/Training:
High School diploma or GED Equivalent
Graduation from Registered Nurse (RN) accredited school
Work Experience:
Must be able to read, write and understand the English language
Prior experience with the MDS process is preferred.
Certification, Licensure, Registration:
Current, unencumbered, active license to practice as a Registered Nurse (RN) in the state of Michigan.
AANC certification preferred. RAC-CT
Knowledge of the Resident Assessment Instrument (RAI) process, including the principles the Prospective Payment Process (PPS) strongly preferred
Remains current with American Association of Nursing Assessment Coordinators (AANAC) requirements
Other Qualifications:
Promotes and protects patients’ rights; treats patients with dignity and respect; reports suspected abuse or neglect.
Demonstrates flexibility to adjust own responsibilities and timetables to meet the needs of staff, department and facility
Conducts education to MDS staff on updates related to insurance cuts, changes, and/or appeals
Knowledgeable and experience with case management and obtaining continued authorizations from insurance companies and the ability to update in EMR
Maintain knowledge and keep abreast of changes related to long term care issues.
Maintain and monitor compliance of state and federal rules and regulations related to RAI to ensure organizational compliance.
Maintain current working knowledge of Medicare criteria, serving as a resource for nursing staff and communicate changes in regulation
As needed, enters or records data timely and accurately; protects confidentiality of patient information; protects data against loss or destruction; reports suspected violation of security/confidentiality issues.
Must be willing to accept and work toward progress, change and high standards of accomplishments for self and others
Actively participate in team development to enhance the cohesion and performance of the MDS staff at each facility while demonstrating strong interpersonal skills and cooperation
Perform other tasks, as requested, to meet the goals and objectives of the organization
Must attend and participate in professional activities and programs.
Have the ability to be flexible and perform other duties as assigned.
Working Conditions:
Works in office as well as throughout each facility of the organization
Sits, stands, bends, lifts and moves intermittently during working hours.
Is subject to frequent interruptions.
Is subject to hostile and emotionally upset employees, residents, family members, etc.
Communicates with the medical staff, leadership team, Nursing staff, and other members of the health care team.
Works beyond normal duty hours, on weekends, and in other positions temporarily, when necessary.
May be exposed to blood, body fluids, infectious waste, diseases, conditions, air contaminants etc., including the AIDS and Hepatitis B viruses including COVID-19.
May be exposed to chemicals for cleaning and sanitation purposes.
There may be instances of standing, walking, sitting, bending, stooping, squatting, grasping/gripping, finger dexterity, writing/data entry, lifting/carrying (up to 25 pounds).
There may be instances of climbing stairs, pushing or pulling, reaching above shoulders.
