Description

Position Summary:

In keeping with our organization’s goal of improving the lives of the Residents we serve, the Nurse Assessment Coordinator (NAC) plays a critical role in providing leadership in the management of the Minimum Data Set (MDS) and utilization management process in accordance with current federal, state, and local standards. The NAC will provide oversight and perform essential functions in relation to assigned facilities. NAC will ensure the integrity of the MDS data submitted, ensuring it represents appropriate Clinical Reimbursement for Medicare and PDPM/PPS Case Managed residents, QRP, and Quality Measures. 

Principal Duties and Responsibilities:

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Keep abreast of current federal and state regulations, as well as professional standards.
• Ensure all OBRA tracking forms and assessments are scheduled per RAI guidelines 
• Review Medicare A (Managed Care if utilizing PDPM) admissions to assure that the necessary referral records are obtained to provide comprehensive care to the resident and provide the necessary documentation to support MDS coding and plan of care 
• Assign primary ICD-10 code for all Medicare A and Managed Care residents that are utilizing PDPM 
• Schedule all necessary Medicare and Managed Care MDS assessments that are required for reimbursement per CMS and managed care guidelines
• Collaborate with NAC team to ensure assessments are completed timely, NAC will work with team to ensure MDS resources are utilized appropriately per center’s assessment schedule
• Transmit assessments per CMS guidelines, reviewing validation reports, warnings, and rejections 
• Observe TSI analytic alerts that could indicate an MDS coding, Care Area, or Reimbursement concern and address appropriately with the Clinical team
• Conduct Quality of life meetings to establish OBRA schedule. Team meetings will allow for review of Quality Measures, resident goals, and key metrics to maintain a resident’s highest practicable level 
• Attend weekly UR meetings as allowed with Schedules to lead comprehensive discussion of skilled residents with a Med A and B payer source. Facilitate discussion and provide determination that residents continue to meet skilled level of care and meet Medical necessity per Medicare guidelines. Review Medicaid LOCD compliance during UR meeting and discuss with IDT any residents (including non-skilled residents) that may qualify for SCSA or IPA 
• NAC will communicate with IDT regarding clinical needs or changes.
• Conduct monthly Triple Check meeting 
• Assist in guiding the MDS Coordinator and IDT to ensure MDS coding and supportive documentation are an accurate representation of the resident and meets regulatory and auditor requirements.
• Participate in QAPI processes in centers that relate to accurate coding, clinical reimbursement, and compliance. Assure that established infection control and standard precaution practices are maintained when providing care. Follow established safety precautions when preforming tasks and using equipment and supplies.

Requirements

Required/Desired Qualifications:

Education, Training, and Experience:

• Current State License as a Registered Nurse
• CPR Certified
• Knowledge and training in all aspects of MDS process.
• One year of experience as an RN in a long-term care setting.

Specific Skills, Knowledge, and Abilities:

• Effectively communicates with the IDT by mentoring and evaluating the activities and performance of the RAI Process. 
• Knowledge of current federal and state laws and regulations that apply to the practice of nursing in a long-term care setting. 
• Has strong organizational and time management skills and the ability to prioritize responsibilities.
• Ability to apply mathematical concepts such as fractions, percentages, ratios, and proportions to practical situations.
• Basic computer knowledge is required.