MDS CARE PLAN COORDINATOR at Orchestra

Salem, Illinois, United States -

Full Time

Start Date

Immediate

Expiry Date

29 May, 26

Salary

48.0

Posted On

28 Feb, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

MDS Assessment, Care Plan Coordination, Medicare Processes, RAI Management, Documentation, Regulatory Compliance, Interdisciplinary Team Coordination, Physician Certification, Benefit Tracking, Appeals Processing, Medicaid Reimbursement, Data Submission, Error Correction, Team Leadership, Communication, Nursing Services

Industry

Financial Services

Description

Description The overall purpose of the MDS Care Plan Coordinator is to manage the integrity of the facility’s RAI and Medicare processes. This includes assuring that residents receiving Medicare services qualify for those services, that all documentation required to support continuing stay is completed, that MDS/PPS assessments are completed timely and accurately according to regulations and that skilled nursing care is provided on a continuing basis. ESSENTIAL DUTIES AND RESPONSIBILITIES Performs duties and responsibilities with assigned functional area within a nursing home facility which may include, but are not limited to, any combination of the following tasks: Obtain and maintain timely physician certifications for each Medicare resident. Coordinate preparation of MDS and Care Plans as per regulatory requirements. Update care plans as needed or indicated. Maintain MDS Care plan schedule for interdisciplinary team. Invite families and/or residents to participate in care plan meetings. Assist residents to care plan meetings. Assure daily documentation of assessment for each Medicare resident daily. Verify daily Medicare documentation is appropriate and meets Medicare coverage guidelines. Track Medicare resident benefit days and validate daily Medicare census and coordinate this information with the Business Office Manager to assure accurate billing. Coordinate weekly Medicare meeting with Interdisciplinary Team. In cooperation with the Social Service Director, keep responsible parties/residents abreast of continuing or ending Medicare coverage. Complete responses to requests for additional information from the intermediary and appeals decisions, when necessary, within established time frames. Assure preparation of Medicare denial letters for each resident discharged from Medicare coverage within time limits imposed by Medicare guidelines. Participate in the ongoing evaluation of documentation required for Medicaid reimbursement. Monitor the appropriate MDS web site for up to date changes. Submit MDS assessments to E-Health for analysis and corrects as needed. Transmit assessments per regulatory guidelines to the state repository, receives validation reports, corrects errors, and resubmits as needed. Monitor compliance with Dart Chart documentation for nursing personnel. Maintain RUG variance rate of less than 2% as compared to DART Chart System Calculations. Ability to function as a Team Leader/Role Model Assure that each resident’s attending physician and family or responsible party is promptly notified of any significant change in the residents’ health conditions. Is familiar with the Abuse prevention policy and knows responsibility to enforce it. Assist in the provision of treatments, medications, and nursing services as needed. Required to be “on call” as needed by the facility. Participate in ongoing staff education/orientation. Support Director of Nursing/Assistant Director of Nursing by assuring that nursing staff follow facility policies/procedures. PHYSICAL DEMANDS Ability to communicate in English via phone, in writing, and verbally in conversations with different levels of staff, patient families, and any outside customers. The physical demands described are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is frequently required to stand and walk. The employee is occasionally required to sit; use hands or fingers, handle, or feel; reach with hands and arms; talk or hear; and taste or smell. The employee must occasionally lift and/or move up to 50 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception, and ability to adjust focus. Ability to utilize a computer, phone, etc. for extended periods of time. While performing the duties of this job, the employee is occasionally exposed to blood or other body fluids, fumes, or airborne particles and toxic or caustic chemicals. The noise level in the work environment is usually moderate. Requirements A current, valid State Nurse license is required. Education/and or experience in long-term care, acute care, or geriatric nursing preferred. MDS/RAI experience highly preferred. Functional literacy in English is required. No disqualifying criminal offenses as defined by regulatory guidelines. Proficiency in computer use/data entry. Offers of employment are contingent upon completion of a successful background check and drug screen. Helia Healthcare, LLC is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We are committed to building a team that represents a variety of backgrounds, perspectives, and skills. The more inclusive we are, the better our work will be.

Responsibilities

The primary role involves managing the integrity of the facility's RAI and Medicare processes, ensuring residents qualify for services, and that all required documentation for continuing stay is completed accurately and timely. This includes coordinating MDS/PPS assessments, verifying documentation, tracking benefit days, and communicating coverage status to residents and responsible parties.