QUALIFICATIONS:

Required

• Current LVN license
• CPR certified required; 30 days will be given to complete a course and get certified
• Excellent knowledge of RAI Process, the federal Medicare PPS process, and Medicaid reimbursement as required
• Thorough understanding of the Quality Indicator process
• Knowledge of the OBRA regulations and Minimum Data Set Knowledge of the care plan process

Preferred

• 2 years nursing experience in long term care/skilled nursing

PHYSICAL REQUIREMENTS: The ability to safely perform movements such as pushing, pulling, lifting, bending, kneeling, and reaching up to 50 pounds with or without reasonable accommodations
WORK SCHEDULE: As assigned, including some weekends, evenings and holidays
WORK ENVIRONMENT: Clinical
Caraday Healthcare provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, genetics, or any other characteristic protected by law

• Assist the facility in assuring adherence to federal and state regulations and certification
• Actively participate in the regulatory or certification survey process and the correction of deficiencies
• Report trends from completed audits to the Quality Assurance Committee
• Ensure completion of the RAI Process from the MDS through the completion of the plan of care
• Initiate and monitor RAI process tracking, discharge/re-entry, and Medicaid tracking forms through the PCC & SimpleLTC systems
• Follow up with staff when necessary to ensure compliance to standards of documentation
• Collect data for each resident and interviews staff and residents as necessary to assure good standard of practice and as instructed in the most current MDS user manual
• Facilitate 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
• Provide interdisciplinary schedule for all MDS assessments and care plans as required by OBRA and PPS
• Ensure appropriate signatures are obtained as required
• Ensure that the interdisciplinary team makes decisions for either completing or not completing additional MDS assessments based on clinical criteria as identified in the RAI manual
• Respond to change in conditions appropriately
• Coordinate scheduling notice of patient care planning conference and ensure communication of outcomes/problems to the responsible staff, patient and/or responsible party
• Ensure all MDS information and care delivered as outlined in the Care Plan is supported by documentation
• Assist the Administrator/Director of Nursing with monitoring to ensure that a care plan is initiated on every patient upon admission to the center
• Participate in the daily Interdisciplinary Team meeting and communicate needs for changes in PPS Timeliness and Assessment Reference Dates and deficiencies in completion of MDS, CAA and Care Plan
• Relay and/or act upon information from the Clinical Reimbursement Specialist audits
• Act as a resource person for computer issues that relate to the MDS process; contact the help desk when indicated
• Maintain proficiency in software programs
• Responsible for ensuring appropriate Medicare coverage through regular communication with Clinical Reimbursement Specialist Sequence appropriate diagnosis coding for residents
• Correct and ensure completion of final MDS and submit resident assessment data to the appropriate state and Federal government agencies in a timely manner
• Assign, assist and instruct all staff in the RAI Process, PPS Medicare, Medicaid (Case Mix as required) and clinical computer system in relation to these processes
• Ensure timely submission of the MDS to the state with proper follow up on validation errors; maintains validation records from the submission process in a systematic and orderly fashion
• Maintain confidentiality of necessary information
• Remain proactive with staying current on all industry changes
• Assist with OIG reviews, ADR’s, RAC audits, etc. as needed with professionalism
• Coordinate monthly Triple Check meeting for Medical billing compliance
• Complete LTCMI timely on TMHP portal and communicate with BOM regarding payer changes to ensure no loss in Medicaid payment
• Understand and adhere to the guidelines of “Residents Rights” and assure resident safety
  Requirements: