MDS Care Coordinator RN

2 weeks ago


Rhinebeck New York, United States ArchCare Full time

Position Overview:

Role:
MDS Care Coordinator RN

Organization:
ArchCare

Location:
Not specified

About Us:


At ArchCare, we are dedicated to providing compassionate care to individuals of all backgrounds and beliefs, ensuring they receive support in the environments where they feel most at ease – whether at home, within the community, or in skilled nursing facilities.

As the Continuing Care Community of the Archdiocese of New York, we view our mission to enhance the lives of our elderly population and those requiring additional assistance as a profound responsibility and a calling.



Benefits and Advantages:
Includes accrued time off for vacations, illness, and holidays.

Participation in a retirement savings plan (403(b)).

Optional Benefits:
Short-Term Disability, Life Insurance, Cancer Insurance, Pet Insurance.

Discounted Services:
Access to Plum Benefits, NYSC Gym.

Utilize pre-tax dollars for eligible commuting expenses.

Key Responsibilities:

Core Duties:

  • Oversee the completion of Admission/Re-Admission, Annual, and Significant Change MDS Care Area Assessments (CAAs), ensuring that each resident's comprehensive care plan is tailored to their individual needs and complies with relevant State and Federal regulations.

Adhere to the RAI Manual Chapter 4:
CAA Process and Care Planning standards.

  • In accordance with 42 CFR b), guarantee that the comprehensive care plan includes measurable objectives and timelines, detailing the services necessary to achieve or maintain the resident's optimal physical, mental, and psychosocial well-being.
  • Ensure all MDS Care Area Assessments (CAAs) are finalized by the assigned department within the designated timeframes.
  • Develop and implement the Baseline Care Plan for each resident within 48 hours of admission, incorporating instructions for effective, person-centered care that meets established professional standards. Initial goals should be based on admission orders, physician directives, dietary requirements, therapy services, social services, and PASARR recommendations, if applicable.
  • Provide residents and their representatives with a summary of the baseline care plan, including initial goals, medication summaries, and dietary instructions. Maintain documentation of resident/representative or family acknowledgment of the Baseline Care Plan with signatures and dates.
  • Ensure the Initial Comprehensive Care Plan is accurate, encompassing all clinical care provided, medication classifications, and ICD 10 Diagnoses coded on the MDS, along with corresponding goals and interventions.
  • Update Quarterly MDS Care Plan Goals and interventions as indicated in clinical records, including medication classifications and new ICD 10 Diagnoses Codes.
  • Organize Comprehensive Care Plan committee meetings, ensuring that the resident's care plan reflects all triggered Care Area Assessments, diagnoses, and individualized needs.
  • Lead Care Plan Meetings with the Interdisciplinary Team (IDT), ensuring that residents, representatives, and families are invited to care plan meetings for initial admissions, readmissions, significant changes, quarterly, and annual reviews, in collaboration with the Nurse Manager and Social Worker for assigned units. Ensure that Care Plan Meeting notes are accurately recorded in the Electronic Medical Record (EMR).
  • Participate in Weekly Utilization Review Meetings for assigned units with the Nurse Manager, Therapy, and Social Worker to discuss coverage and continued stay/discharge plans across all departments. Ensure that any recommendations from therapy to nursing for the Certified Nursing Assistant (C.N.A.) assignments are updated in the Care Plan and C.N.A. documentation for accurate care provision.
  • Maintain up-to-date Care Plans/C.N.A. Assignments to reflect current Advance Directives, Activities of Daily Living (ADLs), toileting, and special care requirements.
  • Collaborate daily with the Nurse Manager of assigned units to ensure that all documentation is current and that care plans are regularly updated to reflect the quality of care provided.
  • Attend daily morning meetings and review the 24-hour report to ensure that care plans are continuously revised to reflect changes in resident conditions and care (42 CFR b), Comprehensive Care Plans).
  • Review the Provider Matrix and 672 for assigned units to ensure all areas are addressed in the resident care plan. Assist the Nurse Manager with updates and accuracy for New York State Department of Health Survey Inspections.
  • Ensure that resident vaccinations are administered and offered promptly in collaboration with the Nurse Manager and MDS Nurse.
  • Conduct Routine Clinical Rounds daily to assess and confirm that documentation accurately reflects the care provided.
  • Engage with residents, families, and staff daily to address care concerns and revisions, ensuring a high level of customer service and quality care.
  • Understand the Quality Measure Criteria and its implications for the CMS Five Star Rating System for the facility.
  • As part of the Nurse Leadership Team, attend meetings with the Chief Nursing Officer (CNO), Chief Clinical Officer (CCO), and Nurse Managers as needed to review Quality Measures and necessary documentation system changes to enhance efficiency, quality of care, and accuracy of MDS data and care plans.
  • Conduct Quality Assurance audits as assigned and submit evaluations of these results promptly.
  • As a vital member of the IDT, the designated workspace will be resident unit-based to perform job duties as a Clinical Leader and serve as the primary resource for Clinical Documentation and Quality of Care.

Employment Type:
Full Time

Compensation:
$48.00 per hour

Qualifications:

Educational Background:
High School Diploma or equivalent; college degree preferred.

Experience Requirements:
Minimum of 1 year of MDS experience.

Licensure Requirements:
Current New York State RN license; MDS Certification preferred.
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