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MDS Director RN
1 month ago
POSITION SUMMARY
The MDS Director is responsible for ensuring the completion of the MDS (minimum data set) assessment and transmission to the Center for Medicare and Medicaid Services. They utilize the data collected to develop a comprehensive care plan that addresses the emotional, physical, and mental abilities of each resident. The plan is formulated in collaboration with the interdisciplinary team and the family and resident to provide goals for the resident’s safety, and long-term and short-term health. Other responsibilities include creating reports for the Center for Medicare and Medicaid Services using the minimum data set system.
ESSENTIAL JOB FUNCTIONS
A. Role Responsibilities:
Complete the Resident Assessment Instrument (RAI) process, including MDS’s CAA’s, care plans and other assignment to meet Federal and State regulations and quality expectations. Ensure completion of all required reports according to prescribed time frames. Ensure appropriate staff is informed of all significant changes of condition and facilitates accuracy of all MDS information.
Promote clinical care that meets professional standards of practice with an emphasize on a person-centered philosophy.
Assist in the creation of supporting systems that enable staff and empower team members to jointly plan and deliver care. Be role models in the collaboration and partnership with physicians, primary staff, residents, families, and the departments.
Provide visionary leadership by using leadership principles to anticipate and influence change, determine resources and actions needed to accomplish objectives, set priorities and manage time effectively, identify potential problems/opportunities and plan contingent action, develop new and unique ideas to improve existing systems or operations, encourage innovative efforts in others, and give clear directions, explain reason for decisions, and solicit the input of staff to enhance group capabilities.
Review all assigned quality reports/activities that affect quality of care and quality of life for residents. Identify gaps in existing work processes and participate in a resolution. May assist the Director of Nursing in the facilitation of the annual development and implementation of a QI Plan, addressing all aspects of clinical objectives.
Serve as a clinical resource to safely manage admission, discharge, and transfers. Review admission and re-admission orders.
Promote clinical care that meets professional standards of practice with an emphasis on the person-centered philosophy.
Implement care/services that recognize age/diversity specific needs/issues of customers served by demonstrating awareness of human and resident’s rights in all aspects of care, treating each resident and co-worker with respect and dignity and, and maintaining confidentiality.
Work collaboratively with Environmental Service and other departments to maintain a safe environment for each resident, maintain awareness of accident prevention practices, and provide a safe environment for the residents and staff.
MDS Job Description
Perform other related duties as required.
Determine potential PDPM Health Insurance Prospective Payment System (HIPPS) codes or potential Resource Utilization Group (RUGs) to estimate payment and expense associated with a potential admission.
Complete and ensure the accuracy of the MDS process for all residents.
Maintain current working knowledge of Medicare criteria and communicate changes in regulations.
Monitor Case Mix Index (CMI) scores by looking for potential risks and/or changes that may affect Medicaid Reimbursements.
Monitor Medicare assessment schedule and nursing documentation to ensure accuracy and timely submission.
Coordinate and oversee the resident assessments, as well as care planning to provide the highest quality care.
Prepare, file, and track electronic paperwork submission including required Medicare and Medicaid documentation.
Work in collaboration with all IDT members and departments, and communicate PPS and OBRA MDS
Monitor charting and documentation for completeness and accuracy as necessary to ensure standards are met; review with unit aides, restorative aides, licensed nursing staff, therapy, activity staff, social service and dietary during the MDS look-back period, care plan developments and revisions and as needed.
Determine clinical eligibility for Medicare A.
Stay up to date with current guidelines and regulations for both state and federal.
Print and distribute Quality Indicators to be reviewed and utilized for areas of improvement.
Provide Quality Measure reports to the DON for use in the QA process.
Ensure that significant changes identified through the MDS process are communicated to all IDT members.
Notify unit nursing staff, nursing supervisor and DON of any identified care concerns.
Attend morning meeting daily to monitor order changes, resident significant changes in status/change of condition, new care plan needs, payor changes, census changes (new admissions, readmissions, deaths, room changes, hospitalizations etc.)
Lead the daily PPS (Prospective Payment System) stand-up meeting with the therapy director to manage/coordinate Medicare, Managed Care, and Medicaid caseloads, processes.
Lead the weekly Care Plan, Medicare, Managed Care, Medicaid meeting with the IDT (MDS, Therapy Manager, Restorative Nurse (as applicable), DON, ADON or Nursing Designee, BOM, Admissions Director (as applicable), Social Service Director, Dietary Director, and Activity Director.
Lead the Triple Check meeting monthly with IDT for Medicare and Managed Care Billing.
Attend all required meetings (Fall, Nutrition at Risk, Wound, Behavior, Triple Check Meeting Monthly for billing).
Code and sequence ICD-10 Diagnosis according to current guidelines.
Communicate with Regional MDS Consultants (facility resource support) to determine skilled coverage and adherence to CMS (Centers of Medicare and Medicaid Services) standards/guidelines.
Complete all required PPS MDS assessments per state and federal guidelines and complete all OBRA MDS assessments (Initial Full Comprehensive, Quarterly, Annual, Significant Change, OSA – other state required assessment as applicable to calculate a RUG score, signification correction assessments and MDS modifications as applicable)
Complete Care Area Assessments (CAAs) required according to the MDS triggers.
Complete all MDS Tracking forms upon admission/re-admission/discharge/ death as applicable.
Prepare and implement appropriate procedures to meet the needs of Medicare, Managed Care or Medicaid Reimbursement Audits as applicable.
Conduct daily nursing unit observations for quality assurance, compliance, and education purposes.
Establish MDS Schedules and maintaining all resident’s MDS for both regulation and compliance as well as Medicare/Medicaid Reimbursement.
Audit MDS supportive documentation for timeliness and accuracy. Continued non-compliance should be reported to the facility Administrator and DON.
Complete required audits.
Perform on-going monitoring of the QM – Quality Measure Reports for MDS coding issues and/or resident concerns.
Attend scheduled in-services, staff meetings, workshop, seminars, and quarterly regional training meetings. This also includes attending seminars and training specific to furthering MDS education as needed.
Complete and manage the Certification and Recertification forms per CMS guidelines.
Review and obtain post admission Insurance Authorizations per facility policy and procedure.
Manage Advance Beneficiary Notifications.
Manage the POC tasks – ADL and Restorative Programming.
Manage and coordinate the Baseline Care Plans.
Participate in coordination of resident services through departmental and staff committee meetings (i.e.: QAPI)
Guardian Angel Rounds
Manage weekly update of the CMS 802 and 672.
Participate in the Nonclinical IDT weekend Rotation Schedule.
QUALIFICATIONS:
Must possess a valid RN license in good standing according to state and federal requirements.
Possess a minimum one (2) year of experience in nursing service administration and/or prior MDS Coordinator position for one (2) year.
Completion of an accredited MDS Certification Course with certification letter-Preferred
Possess strong knowledge of state, federal or local regulations as they pertain to Long-Term Care
Must have patience, tact, a cheerful disposition, and enthusiasm, as well as the willingness to handle difficult situations.
Possess strong knowledge of the CMS MDS 3.0, PDPM Reimbursement System, State RUG Reimbursement System, Case Mix - CMI, and the CMS Five Star System – Quality Measures.
The ability to be discreet and protect the integrity of confidential information and stay within Corporate Compliance and HIPPA.
Must have knowledge and understanding of computers and software (i.e.: Word, Excel, Power Point, Point Click Care etc.)
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