CCM/MDS Director

1 month ago

Atlanta, United States Nursecare of Buckhead Full time

This position is for an MDS Director with a $2000 Sign-on bonus

MUST HAVE Experience

SUMMARY

Coordinates and facilitates the timely and accurate completion of both the RAI and Care Management process from admission to discharge in accordance to company P and P, MPGs, State and Federal guidelines, and all other entities as appropriate. May coordinate information system operations and education for the clinical department.

Coordinate delivery of services to managed care and Medicare Residents in collaboration with the facility's team members. The Case Manager monitors and assists in documenting the clinical treatment and care provided. He/she facilitates and serves as the resident and family advocate and acts as a liaison to insurance and medical management professionals.

ENTRY QUALIFICATIONS

  • RN preferred or may be LPN/L VN with approval from the facility Administrator and appropriate District/Regional staff
  • Must be in good standing with Board of Nursing
  • Knowledge of Medicare process preferred
  • Current State nurse license
  • CEU's as required by the State
ESSENTIAL DUTIES AND RESPONSIBILITIES

This list is subject to individual facility policies, procedures and practices, which may require additional duties and responsibilities.
  • Works in collaboration with the Interdisciplinary Team to assess the needs of the
    resident
  • Works with and receives direction from Regional Clinical Reimbursement
    Consultant
  • Coordinates and manages daily care management meeting, which includes review of resident care and the setting of the Assessment Reference date
  • Enforces accurate and timely resident assessments according to State and Federal regulations
  • Designates responsibility for completing sections of the assessment to the
    interdisciplinary team
  • Completes accurate coding of the MOS with information obtained via medical record review as well as observation and interview with facility staff, resident, and family members
  • Maintains the tracking system of MOS schedules (time frames and due dates)
  • Maintains the frequent and accurate data entry of resident information into
    appropriate computerized MOS programs
  • Coordinates care plan conferences with the interdisciplinary team, residents and
    families
  • Obtains, reviews and maintains all State and Federal reports, making appropriate corrections timely
  • Coordinates education related to the RAI/Care Management process for the facility
  • Coordinates the electronic submission of required documentation to the State
    database and other entities per company policy and State and Federal regulations
  • Completes required forms and documents in accordance with Company policy and State and/or Federal regulations
  • Attends Interdisciplinary Team meetings and other meetings in order to gather
    information, communicate changes and maintain and update records
  • Contact RCRC for Medicare compliance
  • Continually updates knowledge base related to data entry and computer
    technology
  • Participates in quality assurance activities
  • Completes electronic submission of required documentation to the State database and other entities per company policy
  • Perform other duties as assigned
  • Ensure all hospital documents have been gathered and collected in order to complete pre-admission assessment is completed
  • Coordinate with admission department to gather any additional supporting documentation from referring hospital
  • Initiate and complete "Pre-admission screen assessment tool" in Point Click Care
  • Input Physician Orders into the que for the Admission Process
  • Meet with the facility IDT team to coordinate services for the residents' total regimen of care
  • After completion of Admission Nurse assessment, (CCM) will ensure admission checklist items have been completed by nurse/CCM and complied with post admit
  • Review care pathways and care task to ensure the supporting documents are available and appropriate
  • Lead and maintain the PDPM workbook and huddle for every skilled resident
  • Coordinate the 48 hr. care plan and delivery of service meeting with IDT team, resident and/or resident representative
  • Ensure thorough and timely communication with managed care/insurance case managers to coordinate certification and concurrent stay programs
  • Maximize benefits by coordination of cost effective care, avoid fragmented care and duplication of services and ensure the appropriate level of care is provided in the most suitable setting
  • Meet with facility interdisciplinary team to coordinate services to ensure that the resident's total regimen of care is maintained
  • Participate in all Medicare and managed care resident interdisciplinary meetings
  • Work with team members to ensure discharge planning goals and objectives are developed and discussed at the interdisciplinary team meetings
  • Assist in planning the services required in the resident's discharge plan as necessary
  • Maintain communication with facility business office and medical records to ensure accurate census and payment of managed care and Medicare residents
  • Meet with residents, and/or family members, as necessary. Report problem areas to department directors
  • Agree not to disclose assigned user ID code and password for accessing resident/facility information and promptly report suspected or known violations of such disclosure to the Administrator
  • Agree not to disclose resident's protected health information and promptly report suspected or known violations of such disclosure to the Administrator
  • Report any known or suspected unauthorized attempt to access facility's information system

PHYSICAL DEMANDS AND ENVIRONMENT

Working in normal office environment, employee may be required to sit, bend, stoop, use keyboard, see, talk and hear. May occasionally lift medium to heavy objects including with the movement of residents. May assist in lifting residents weighing between 100-250 lbs. Employee is occasionally exposed to blood or other bodily fluids, fumes, or airborne

particles and toxic or caustic chemicals. Employee is occasionally exposed to blood or
other bodily fluids, fumes, or airborne particles and toxic or caustic chemicals. In
compliance with applicable law, reasonable accommodations may be made to enable
individual with disabilities to perform the essential functions of the position.

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