POSITION SUMMARY: The Clinical Case Coordinator (LPN) coordinates the development, completion and transmission of the resident assessment in accordance with the regulatory requirements, reviews and manages reimbursement in compliance with Genesis policies and procedures. Responsible to case manage residents covered by either Medicare or Managed Care insurance programs.
RESPONSIBILITIES/ACCOUNTABILITIES:
1.Coordinates the completion of the resident assessment (MDS), Triggers and RAPs in accordance with current rules, regulations and guidelines that govern the resident assessment.
2. Responsible for maintaining the calendar and assessment communication board.
3. Participates in at risk Action Team meetings as directed by administrator.
4. Assist with education and overall plan of care.
5. Identify change in condition in conjunction with IDT.
6. Conducts and coordinates facility daily PPS meetings and IDT Process and Claim review.
7. Coordinates appropriate length of stay for skilled nursing and rehab residents in conjunction with IDT.
8. Reviews documentation to ensure state, federal and third party payor guidelines are met to support skilled coverage in conjunction with IDT.
9. Coordinate submission assessments through LTCQ program and makes the recommended corrections or documents justification on report.
10. Participates in the facility Quality Management. Serves on Revenue Enhancement Committees and develops/implements improvement.
11. Participates in the review Quality Indicator report and Resident Specific Profile no less than monthly. Analyzes and addresses flagged areas in conjunction with the interdisciplinary team. Provides Administrator and Director of Nursing Services with the QI Report and an analysis of flagged areas.
12. Attends/participates in educational programs to maintain knowledge current with RAI/PPS regulations.
13. Attend facility in-services and department/facility meetings as applicable.
14. Maintains and implements department policies and procedures, ensures staff compliance.
15. Ensures that all OSHA and safety standards are followed, as applicable to the position and in the business location or workplace.
16. Maintains safe and clean work area and adheres to location/company safety standards for the healthcare professional.
17. Complies with all Infection Control, Standard Precautions and OSHA standards for the healthcare professional.
18. Complies with applicable legal requirements, standards, policies and procedures including but not limited those within the Compliance Process, Code of Conduct and HIPAA.
19. Provides leadership and support for the Compliance Process within management area.
20. Promotes adherence to applicable legal requirements, standards, policies and procedures as specified within the Compliance Process, Code of Conduct, Federal False Claims Act and HIPAA within management area.
21. Distributes compliance-related materials within management area.
22. Ensures timely and accurate reporting and responses to compliance-related issues and monitors the implementation of corrective action plans related to such issues.
23. Ensures that staff participates in orientation and training programs including but not limited to all required compliance courses and relevant policies and procedures, and that such training is properly documented.
24. Provides open lines of communication regarding compliance issues within management area through the Four Step Reporting Process and access to the confidential disclosure program reporting lines and ensures that retaliation against staff who report suspected incidences of non-compliance does not occur. Reports concerns and suspected incidences of non-compliance using the 4-Step Reporting Process.
25. Participates in monitoring and auditing activities and investigations, and implementing quality improvement processes, as required.
26. Completes performance reviews and determines compensation and promotions based on the accomplishment of established standards that promote adherence to compliance and quality standards.
27. Participates in compliance and other required training programs.
28. Prepares compliance reports, as required.
29. Adheres to location protocols and department/company policy and procedures.
30. Adheres to established HIPAA confidentiality standards of patient/resident and client location information.
31. Maintains on-site regular attendance as scheduled.
32. Performs all other tasks or duties as assigned.
CCNL
Qualifications:
SPECIFIC EDUCATIONAL/VOCATIONAL REQUIREMENTS: 1. LPN/LVN degree required.2. Preferred experience in long-term care.3. Demonstrated proficiency in RAI/PPS processes.4. Current LPN/LVN license and/or certification in state of employment.
Other Info
Pay Target: $38.00 to $40.00
Job City: Thornton
Requisition Number: 444992
Not Stated