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Resident Care Coordination Specialist
2 months ago
Location
Windsor Arbor View
Employment Type
Full Time
Category
Nursing
Role Summary
The Care Management Specialist is pivotal in overseeing the Resident Assessment Instrument (RAI) process, ensuring that resident evaluations are completed accurately and promptly, in compliance with Medicare, Medicaid, OBRA, and other payer program standards. This role guarantees that assessments reflect the comprehensive physical, mental, and psychosocial condition of each resident, while also ensuring that documentation supports the services rendered and the accuracy of assessments. Effective communication with interdisciplinary team members is essential.
Key Responsibilities
- Guarantee the timely and precise assessment of residents' health and functional status throughout the assessment period.
- Engage in the pre-admission process to gather critical information for MDS/Case Mix optimization from referral sources.
- Ensure the accurate and timely completion of all Medicare/Medicaid case-mix documentation to secure appropriate reimbursement for services provided.
- Collaborate with the facility's Director of Rehab to determine the most suitable assessment reference date (ARD) for Medicare/Managed Care Assessments.
- Monitor Skilled (MRA/MCO/MCG/MMP) clients using Case Management Tools to ascertain ongoing Medicare/Managed Care eligibility and benefit periods through regular communication with relevant stakeholders.
- Collect necessary information for Managed Care Utilization Reviews during residents' stays and communicate with Managed Care organization's Case Managers as required.
- Ensure compliance with additional Medicare Program requirements, including Physician certification and re-certification.
- Conduct concurrent MDS reviews to ensure appropriate RUGs category is achieved through accurate clinical information capture.
- Participate in interdisciplinary team meetings to identify significant changes in status and facilitate effective care plan development.
- Maintain an organized schedule of all MDS assessments, ensuring proper reference dates throughout residents' stays.
- Track, document, and analyze all default days, implementing corrective actions as necessary.
- Perform modifications/inactivations of assessments in line with CMS Correction Policy and in collaboration with the Regional Care Management Specialist.
- Conduct regular audits of the MDS process, validating coding documentation and evaluating outcomes.
- Ensure timely electronic submission of all Minimum Data Sets, securing backup personnel for this process.
- Review validation reports and ensure appropriate follow-up actions are taken.
- Address issues related to late/missed assessments and review QM and SNF QRP reports monthly.
- Maintain regular communication with the Business Office Manager and Administrator regarding RUG distribution and its reimbursement impact.
- Participate in various meetings as per company policy, assisting in the preparation and submission of Additional Development Requests (ADRs) and other documentation as needed.
- Act as a resource for RAI and Care Management for facility staff.
- Utilize AIS for annual competency training and educational resources as required.
- Assist in orienting and training new staff on the RAI process, ensuring dissemination of updated materials regarding RAI and relevant regulations.
- Manage daily operations of the department.
- Stay informed on reimbursement regulations.
- Organize and maintain data for easy retrieval.
- Adhere to personal hygiene and dress code standards.
- Communicate regularly with the Regional Care Management Specialist regarding clinical reimbursement issues.
- Demonstrate flexibility in work hours to meet business needs.
- Utilize both local and corporate resources effectively in job execution.
- Exhibit superior clinical assessment and documentation skills.
- Demonstrate strong interpersonal skills and the ability to collaborate effectively within a team.
- Perform other duties as assigned.
- Analytical reasoning
- Logical reasoning
- Problem-solving
- Time management
- Organizational skills
- Research skills
- Language proficiency
- Excellent verbal and written communication skills
Education/Training
- Graduate of an accredited nursing program with current R.N. or L.V.N. license.
- Completion of all RIHS-specific MDS/RUGs training modules within the first 90 days of employment.
- Proficiency in standard office software and MDS/RAI-related applications.
- High initiative and capability to lead interdisciplinary teams and manage the RAI process effectively.
- Must hold a valid license in the state of employment.
- Minimum of two years of healthcare experience.
- Experience with MDS completion, reimbursement, clinical resource utilization, and/or case management is highly desirable.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this role. Reasonable accommodations may be made to enable individuals with disabilities to perform these functions.
Regency Integrated Health Services is an Equal Opportunity Employer, committed to a diverse and inclusive workplace.
