Summary:

Coordinates clinical operations to ensure compliance with Medicare guidelines and managed care case management policy.

Qualifications:

• Education:
  • Graduate of an accredited School of Nursing, BS preferred.
• Licenses/Certification:
  • Valid RN license in the state employed.
• Experience:
  • Three years of nursing experience in a long term care environment preferred.

Essential Functions:

• Identifies Medicare entitlement and eligibility for prospective residents.
• Completes weekly chart audits to assess documentation support for skilled Medicare coverage.
• Monitors MDS documentation and charting requirements that support services provided to meeting billing requirements.
• Charts MDS and pertinent narrative data to optimize case mix scores.
• Conducts daily assessments of Medicare patients and coordinates therapy, care mapping and discharge planning.
• Conducts weekly Medicare/case management meetings to review plan of care.
• Performs other tasks as assigned.
• Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.

Knowledge/Skills/Abilities:

• Ability to work cooperatively as a member of a team.
• Ability to communicate effectively with residents and their family members, and at all levels of the organization.
• Knowledge of Medicare regulations
• Ability to be accurate, concise and detail oriented.
• Ability to maintain confidentiality.