Job Description

Job Overview Summary:

Ensures assessments accurately reflect the physical, mental and psychological status of each resident; ensures appropriates documentation to report and support services provided and assessment accuracy. Communicates effectively with other members of the interdisciplinary team.

Follows all Next Step Healthcare policies and procedures.

Note: The following duties are illustrative and not exhaustive. The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or a logical assignment to the position. Depending on assigned area of responsibility, incumbents in the position may perform some or all of the activities described below.

Functions:

• Coordinates timely, accurate, and complete assessment of the resident’s health and functional status during the entire assessment period.
• Ensures accurate and timely completion of all Medicare/Medicaid case-mix documents in order to assure appropriate reimbursement for services provided within the facility.
• Tracks Skilled (MRA/HMA/HMO) customers utilizing Case Management Tools to determine continued and appropriate Medicare/Managed Care eligibility and benefit period through regular communications with Clinical Reimbursement Specialist, Business Office and external Case Managers.
• Ensures that additional requirements of the Medicare Program are met, such as Physician certification and re-certification.
• Participates in the interdisciplinary team process to communicate opportunities, facilitate efficient and effective care plan development and management.
• Ensures the accurate and timely completion of all MDS assessments including PPS, scheduled and unscheduled discharges, Admission, quarterly, annual and significant change.
• Collaborates with the interdisciplinary team to identify significant change in status and implementation of Significant Change in Status MDS.
• Maintains an accurate schedule of all MDS assessments to include the proper reference dates throughout the residents stay.
• Performs Modifications/Inactivation’s of assessments in accordance with CMS Correction Policy and collaboration with Clinical Reimbursement Specialist.
• Ensures the timely electronic submission of all Minimum Data Sets and secures back-up personnel to complete this process.
• Reviews the validation reports and ensures that appropriate follow-up action is
• Reviews Late/Missed assessment reports monthly and addresses issues as
• Reviews discharged managed care with BOM on a weekly
• Participates in month end Triple Check and other meetings per Next Step Healthcare’s
• Facilitates Case Management meeting per Next Step Healthcare’s
• Functions as an RAI and Clinical Reimbursement resource to the facility
• Utilizes Relias annual competency training as well as for educational resource as
• Assists in the orientation and training of new associates on the RAI process and ensures the dissemination of any new or updated materials regarding the RAI and/or Federal and State regulations.
• Ensures timely RN coordinator

Other Duties:

• Maintains current knowledge of reimbursement
• Maintains data in an organized, easily retrievable
• Maintains good personal hygiene and follows dress code
• Communicates regularly with the Clinical Reimbursement Specialist to discuss identified clinical reimbursement concerns and/or opportunities.
• Other duties as assigned or

Qualifications:

• Must be a graduate of an accredited school of nursing with current RN licensure in the state in which employment occurs.
• Minimum of two years health care
• Experience with MDS completion, reimbursement, clinical resource utilization and/or case management is highly desirable.
• Ability to work flexible work hours to support business
• Complete and pass all Next Step Healthcare specific MDS training modules (Relias) within the first 90 days of employment and ongoing per company policy.
• Competency with standard office software applications as well as software applications related to MDS/RAI
• High initiative and ability to efficiently and effectively lead interdisciplinary teams and coordinate and manage RAI process.
• Ability to utilize both local and corporate resources in the execution of job

Knowledge and Skills:

• Customer Service Oriented
• Ability to be patient while interacting with challenged or difficult residents
• Demonstrates organizational and critical thinking skills
• Strong interpersonal skills
• Ability to work independently, problem solve and make decisions as necessary
• Ability to create a resident-centered environment
• Knowledge of policies and procedures and state and federal regulations

Required Responsibilities:

Successful demonstration of work standards, quality work product, productivity, and job knowledge are standard expectations for all company employees.

Core Competencies:

• Caring/Compassion
• Accountability
• Dependability
• Adaptability/Flexibility
• Effective Communication
• Confidentiality
• Team Player
• Dedication

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