Job Overview Summary:

Responsible for the coordination of the Resident Assessment Instrument (RAI) process to ensure accurate and timely completion of resident assessments in accordance with Medicare, Medicaid, OBRA and other payer program requirements.

Ensures assessments accurately reflect the physical, mental and psychological status of each resident; ensures appropriate 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:

• Ensures 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.

• Works in collaboration with the facility Director of Rehab to ensure the most appropriate assessment reference date (ARD) is utilized for Medicare/Managed Care Assessments.

• 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.

• Performs concurrent MDS review to assure appropriate RUG/PDPM category is achieved through the capture of appropriate clinical information.

• 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, 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.

• Tracks, records and analyzes all default days and rectifies if appropriate. Implements corrective action to prevent further default action.

• Performs Modifications/Inactivation’s of assessments in accordance with CMS Correction Policy and collaboration with Clinical Reimbursement Specialist.

• Conducts regular audit of MDS process including validation of coding documentation.

• 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 taken.

• Reviews Late/Missed assessment reports monthly and addresses issues as appropriate.

• Communicates with the Business Office and Administrator on a regular basis regarding RUG/PDPM distribution, default days/unassigned days, case mix index (if applicable).

• Reviews discharged managed care with BOM on a weekly basis.

• Participates in month end Triple Check and other meetings per Next Step Healthcare’s policy.

• Facilitates Case Management meeting per Next Step Healthcare’s policy.

• Functions as an RAI and Clinical Reimbursement resource to the facility staff.

• Utilizes Relias annual competency training as well as for educational resource as needed.

• 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 signatures.

Other Duties:

• Maintains current knowledge of reimbursement regulations.

• Maintains data in an organized, easily retrievable manner.

• Maintains good personal hygiene and follows dress code requirements.

• Communicates regularly with the Clinical Reimbursement Specialist to discuss identified clinical reimbursement concerns and/or opportunities.

• Other duties as assigned or needed.

Qualifications:

• Must be a graduate of an accredited school of nursing with current RN or LPN licensure in the state in which employment occurs.

• Minimum of two years health care experience.

• Experience with MDS completion, reimbursement, clinical resource utilization and/or case management is highly desirable.

• Ability to work flexible work hours to support business requirements.

• Complete and pass all Next Step Healthcare specific MDS/RUGs 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 processes.

• 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 responsibilities.

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

Physical Demands

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Amount of Time

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This job has special vision requirements.

• Close Vision (clear vision at 20 inches or less)
• Distance Vision (clear vision at 20 feet or more)
• Color Vision (ability to identify and distinguish colors)
• Peripheral Vision (ability to observe an area that can be seen up and down or to the left and right while eyes are fixed on a given point)
• Depth Perception (three-dimensional vision; ability to judge distances and spatial relationships)
• Ability to Adjust Focus (ability to adjust eye to bring an object into sharp focus)
• No Special Vision Requirements

This job has special hearing requirements.

• Ability to hear alarms on equipment
• Ability to hear client call
• Ability to hear instructions from physician/department staff