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Regional Assessment Coordinator
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Job DescriptionBasic Function: The Regional Assessment Coordinator is responsible for overseeing managed care programs, ensuring the quality of clinical assessments and care plans across assigned facilities. This role focuses on cost efficiency, compliance with state and federal regulations, and clinical reimbursement processes. Education, Qualifications, Credentials: * Current licensed nurse with active licensure in practicing state (Indiana license as a Registered Nurse preferred). * Two years of managed care experience in a healthcare setting. * Prior experience with MDS processes and at least two years as an MDS Coordinator in a long-term care setting. * Multi-site MDS/Insurance support preferred. * Must have a valid Indiana Operator's license. Responsible To: * Director of Reimbursement * Assistant Director of MDS Coordination Essential Functions: The employee must effectively perform the following essential functions to succeed in this position: 1. Managed Care Responsibilities: o Have knowledge with obtaining precertification for new admissions and communicate with admission teams on authorization status. o Perform audits on navigator documentation for completeness, accuracy, and contractual compliance. o Educate and train new and current navigators in managed care processes. o Provide hands-on assistance with community leadership regarding insurance patient opportunities. o Ensure facilities meet the specifics of each managed care contract and provide recommendations for program success. 2. Clinical Navigation Responsibilities: o Perform facility audits on MDS records for completeness, accuracy, and timeliness. o Oversee the management of information involving resident assessments for case mix reimbursement. o Assist MDS Coordinators in establishing and maintaining cyclical schedules related to the RAI/care plan processes. o Ensure facilities coordinate interdisciplinary care plan meetings with Social Services, family members, and residents. o Monitor trends of facility financial reports and assist in developing action plans to improve care quality. 3. Training Education: o Train and provide direction to new and current navigators and MDS Coordinators. o Conduct regular QA activities to monitor performance and the quality of documentation. o Provide training when new policies and procedures are necessary. 4. Communication Collaboration: o Maintain consistent and effective communication with navigators, MDS Coordinators, and facility staff. o Collaborate with facility administrators and other key staff on managed care, MDS, and clinical navigation initiatives. o Provide reports and updates to the Director of Reimbursement and Assistant Director of MDS Coordination as needed. 5. Quality Assurance Compliance: o Conduct periodic QA audits to promote continual survey preparedness. o Assist in monthly triple check processes and validate billing prior to claim release. o Monitor the effectiveness of staff communications and participate in team meetings as required. Knowledge, Skills, and Abilities: * In-depth knowledge of managed care processes, Resident Assessment Instrument (RAI), interdisciplinary care planning, and MDS regulations and reimbursement guidelines. * Strong problem-solving skills and ability to deal with a variety of variables in complex situations. * Proficiency in reading, interpreting, and applying regulations and contract terms. * Excellent communication skills, with the ability to present information effectively and respond to questions from managers, staff, and the public. Special Requirements: * Must have own transportation and be willing to travel between facilities frequently. * Must be able to work overtime to complete the requirements and tasks of the position. Working Conditions: * Works in a climate-controlled, well-lighted environment with a smoke-free policy. * Regularly works in an office, throughout buildings, and on the road. * Subject to interruptions, noise, and odors daily. * Has some risk of exposure to infections but receives training in hand-washing practices and has access to personal protective equipment to reduce risk. Physical Demands: The physical demands below are typical of those that must be met by the employee to successfully perform the essential functions of the position. Reasonable accommodations may be available for individuals with disabilities. * Lifting/Carrying: 1-10 lbs. (Frequently), 11-25 lbs. (Occasionally) * Pushing/Pulling: 20-50 lbs. (Occasionally), over 50 lbs. (Never) * Climbing/Balancing: Occasionally * Stooping/Bending: Occasionally * Standing/Sitting: Frequently * Walking: Frequently * Travel: Frequently
