MDS Case Manager (RN)

Exciting Opportunity: Join Diversicare as a Care Assessment Coordinator!

Diversicare is seeking a dedicated Care Assessment Coordinator to join our exceptional team and make a difference in the lives of our patients and residents. If you're passionate about promoting a culture of collaboration, quality, and resident-centered care, ensuring accuracy and compliance in MDS assessments, this is the perfect opportunity for you.

Why Choose Diversicare:

• Leadership Opportunity: As our Care Assessment Coordinator, you'll play a pivotal role in ensuring exceptional patient care by overseeing the accuracy and compliance of MDS assessments.
• Upholding Our Values: At Diversicare, we value trust, respect, customer focus, compassion, diplomacy, appreciation, and strong communication skills. As a Care Assessment Coordinator, you'll embody these values and help shape our workplace culture.
• Comprehensive Benefits: Enjoy a competitive benefits package, including competitive salary, medical/dental/vision coverage, an excellent 401k plan, tuition reimbursement, and more.

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ACCOUNTABILITY OBJECTIVE: Maintain and improve compliance with state and federal MDS requirements by delivering accurate, timely assessments and care plans, while promoting a culture of collaboration, quality, and resident-centered care. This position also coordinates and leads the center’s overall case management and discharge planning processes to include effective and efficient utilization of clinical resources to achieve desired results and timely outcomes. The Care Assessment Coordinator ensures all documentation required by the government or insurers is thorough and delivered timely and accurately as mandated.

1.Coordinates the RAI process.
a. Ensures accurate and timely MDS assessments according to state and federal regulations
b. Utilizes the assessment observation period to collaborate with the entire team to ensure thorough documentation supporting the MDS is present in the medical record
c. Provides observations and interviews of center team members, patients, residents and family members for accurate assessment of the resident and patient
d. Ensures interdisciplinary team completes designated sections of the MDS assessment
e. Maintains the tracking system of MDS assessment schedules (timeframes and due dates)
f.  Audits MDS assessments per company guidelines
g. Provides education related to the RAI Process routinely to center team members
h. Coordinates and completes electronic submissions of MDSs per federal
regulations

2. Obtain, review and maintain all state and federal reports, making appropriate corrections timely.

3. Monitors Quality Measures and collaborates with the interdisciplinary team accordingly to
ensure that MDSs are accurate to support and reflect the Quality Measures.

4. Ensures Medicare and Medicaid regulatory guidelines are completed accurately and
timely (i.e certifications, beneficiary notices, skilled documentation, coverage criteria,
etc.)

5. Determines need for non-coverage notification and coordinates communication
with patients/families/payers and the interdisciplinary team.

6. Collaborates with the clinical team in the development and execution of care planning and
conference.

7. Facilitates daily care coordination meetings to ensure care resources are aligned with
benefits and patient needs.

8. Facilitates and participates in the 72 Hour meeting. Ensure collaboration as part of the
care management team.

9. Facilitates the completion of aftercare calls.

10. Responsible for the coordination of the restorative nursing program including
collaboration with the interdisciplinary team.

11. Ensures timely communication with the patient/family regarding changes in condition,
discharge planning, and post discharge communication to be documented in the medical
record.

12. Manages all initial, concurrent, and discharge reviews (Managed Care
authorizations, reauthorizations, and discharge summaries)

13. Responsible for ongoing communication with all insurance case managers.

14. Obtains and records all Managed Care Part B authorizations for the therapy department.

15. Ensures utilization of company tools/resources related to care management –
e.g. PCC, SHP, and Managed Care Master.

16. Ensures timely facilitation of patient care rounds/conferences to review treatment plans
and identify discharge and post discharge needs.

17. Participates in the End of Month Billing Review Foundational Process.

18. Other job assignments as directed by the Administrator.

• Must hold a current RN license in state of employment.
• LPNs will be considered in centers where an RN is present in the department
• Previous MDS/RAI experience.
• Skilled nursing/long term care experience to include regulatory requirements preferred.
• Knowledge of PDPM, managed care reimbursement, utilization and case management as well as discharge planning preferred.
• Experience providing strategic leadership, managing teams and leading projects to achieve desired outcomes.
• Strong verbal, written and interpersonal skills.
• Strong communication, collaboration, and organizational skills required.
• Must be proficient with computers/technology and able to move easily between different software platforms.