Description

Regional Traveling MDS Nurse for Shreveport/Bossier/Ruston, Louisiana

Priority Management Group

Priority Management Group’s vision is to be the preferred provider of care and employer of choice by exceeding the expectations of our residents and their families, creating an exceptional work environment for our staff and promoting excellence in our quality of services provided. We are looking for a full-time Nursing Home Medicaid Pending Specialist to be a part of our incredible team and who has the same vision.

JOB SUMMARY:

In accordance with current federal and state guidelines as well as in accordance with our company’s established privacy policies and procedures; The Regional Traveling MDS Nurse will travel throughout PMGT regions as assigned / scheduled to:

• Support our facility teams with the MDS Coordinator role of coordinating and supporting the RAI process
• Assist as needed with comprehensive review and production of supporting medical records in response to Medicare, Medicaid, and Insurance audits/appeals; risk adjustment/quality reviews; and, as needed, assist with legal/personal medical records requests.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Assist assigned centers and demonstrated competency in the following area:
• Knowledgeable of federal, state, and local government regulations and legislation.
• Knowledge and assistance of the Minimum Data Set (MDS), Resource Utilization Groups (RUG’s), Triggers, Care Area Assessments (CAA’s), Plan of Care, Discharge Plan and documentation requirements per regulations and legislation.
• Proficiently coordinates and supports the RAI process.
• Initiates and monitors RAI process tracking, discharge/reentry and Medicaid tracking forms through the AHT LTC system.
• Follows up with staff when necessary to assure compliance to standards of documentation and compliance.
• Completes patient assessments, data collection, and interviews staff as necessary to assure good standard of practice and as instructed in the current version of MDS User’s Manual.
• Facilitates accurate determination of the Assessment Reference Date that accurately reflects the patient’s care needs and captures all resources utilized to ensure appropriate payment by Medicare/Medicaid and insurance programs.
• Ensures timely submission of the MDSs to the State with proper follow-up on validation errors. Maintains validation records from the submission process in a systematic and orderly fashion.
• Interacts with discharge planners and staff from referring facilities, agencies and hospitals to pre-screen potential patients for admission and readmission to the facility as directed by supervisor.
• Assists/Performs assessments with new admissions, pre-admissions, and readmissions utilizing data collection and recording.
• Verifies that all items on MDS’s or tracking records are complete and attests to completion with signature.
• Manages and collaborates with IDT on pre-admission screening, assignment of observation and look-back periods for the MDS completion including the implementation of a “significant change” MDS/plan of care processes.
• Performs data collection for the MDS process on all patients and reassessments as per the MDS scheduled requirements unless these are assigned to other clinical disciplines for completion.
• Assists in development and revision of plan of care as indicated by the patient’s response to treatment and the effectiveness of the overall plan of care in collaboration with the interdisciplinary team.
• Demonstrates an ability to be flexible, organized, and functions under stressful situations.
• Treats patients and their families with respect and dignity; ensures patient confidentiality and privacy.
• Maintains a good working relationship both with all departments and with contacts from referring facilities and agencies.
• (TX REGION ONLY) Management of TX Medicaid Reimbursement Process through Simple LTC (LTCMI, MESAV, PASRR)
• Proficiently manages the Quality Measure processes as related to the RAI process, VBP, QRP, and QIPP to ensure high quality resident care.
• Flexibly manage tasks to meet deadlines by re-prioritizing workflows in a production-oriented setting
• Employ critical thinking to identify/resolve issues and provide timely feedback regarding medical review processes
• Develop appeal arguments using clinical evidence, supporting references/regulations, and participate in appeal hearings by providing testimony, as required
• Determine regulatory and clinical support for appeal arguments when pre-existing resources are unavailable
• Proficiently review and synthesize abstract information from handwritten/electronic medical records to support claims
• Attend and participate in mandatory in-service training programs, workshops, seminars, etc., as approved / delegated.
• Ensure full compliance with HIPAA regulations
• Working knowledge of ICD-10, CPT coding, HCPCs, and MDS item coding for PPS/PDPM and OBRA assessments
• Respond appropriately to behavioral, medical, and fire safety situations
• Other duties as assigned

Qualifications

EDUCATION:

Must be a graduate of an accredited school of nursing, currently registered with a state agency for nursing licensure, and hold a valid license in the state he/she is employed.

QUALIFICATIONS/EXPERIENCE:

Experience in geriatric/long-term care nursing documentation, Minimum Data Set (MDS) coding, and/or medical necessity reviews/appeals. Working knowledge of regulatory and payer requirements for reimbursement and reason(s) for denial of claims for Medicare, Medicare Advantage, or Medicaid.

Completion of continuing education on subjects related to case management, regulatory requirements, restorative nursing, medical records documentation, legal aspects of documentation, reimbursement, and compliance.

SKILLS/COMPETENCIES

• Analytical - Synthesizes complex or diverse information using experience and judgement to complement data
• Problem Solving – Identifies/resolves problems in a timely manner; develops solutions; works well in group problem solving situations
• Communication – Speaks/writes clearly and informatively; listens and gets clarification; responds well to questions; demonstrates group presentation skills, edits work for spelling and grammar; varies writing style to meet needs
• Quality - Demonstrates accuracy and thoroughness; excellent attention to detail with a critical eye to catch/correct mistakes and errors; applies feedback to improve performance; monitors own work to ensure quality
• Character - Demonstrates integrity in every aspect of work and dealing with others; consistently models desired behaviors and values established by the company; respects diversity of perspective in discussions and demonstrates an inclusive style; demonstrates concerns for job safety for self and others
• Organizational Support - Follows policies and procedures; completes administrative tasks correctly and on time; supports organization's goals and values
• Dependability - Follows instructions and responds to management direction; takes responsibility for own actions; keeps commitments and completes tasks on time or notifies appropriate person with an alternate plan

Priority Management Group, LLC is an Equal Opportunity Employer that does not discriminate on the basis of actual or perceived race, creed, color, religion, alienage or national origin, ancestry, citizenship status, age, disability or handicap, sex, marital status, veteran status, sexual orientation, genetic information, arrest record, or any other characteristic protected by applicable Federal, State or Local laws. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment. Management Group, LLC is an Equal Opportunity Employer that does not discriminate on the basis of actual or perceived race, creed, color, religion, alienage or national origin, ancestry, citizenship status, age, disability or handicap, sex, marital status, veteran status, sexual orientation, genetic information, arrest record, or any other characteristic protected by applicable Federal, State or Local laws. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.