SUMMARY:Develops and completes resident assessments, care plans and oversees reimbursement per Medicare and Medicaid guidelines by performing the following duties:

ESSENTIAL DUTIES AND RESPONSIBILITIES: An individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The requirements listed below are representative of the knowledge, skill, and/or ability required. Other duties as assigned.

Develops and completes resident assessments. This includes but is not limited to: timely completes, transmits, and updates assessments; implements CAAs and Triggers; evaluates the condition, medical background, and special assessment/activities of each resident. Coordinates interdisciplinary meetings to review assessments. 

Assist with plans of care. This includes but is not limited to: ensuring timely completion of comprehensive care plan for each resident, which is designed to meet medical, nursing, mental, and psychosocial needs, and includes measurable objectives to meet such needs; conducting quarterly review or other regular assessment; and ensuring care plan is evaluated and revised for each assessment or status change, including discharge; coordinating timely review of each resident’s care plan by interdisciplinary team. 

Assists with payer coverage matters. This includes but is not limited to: completion of pre-admission assessment; coordinating Medicare and payer coverage; analyzing clinical financial issues for the RAI process; communicating concerns to appropriate staff; review clinical and therapy documentation to ensure residents are placed in the correct/appropriate resource utilization group (RUG) level and assisting with coding; ensuring documentation supports covered services per Medicare charting guidelines. Communicates with assessment team regarding complete and accurate assessment functions to support billing. 

Act as Chairperson of the Interdisciplinary Care Plan Team. Works with Interdisciplinary Care Plan Team in developing a comprehensive resident assessment and care plan for each resident. Provides training to staff in regard to RAI process. Trains, evaluates, monitors and coordinates documentation to support MDS. 

Ensures proper documentation is maintained. This includes but is not limited to: verification that each portion of every assessment is signed and dated by the person completing that portion of the MDS. 

Performs quality assessment and assurance functions. This includes but is not limited to: conducting ongoing review of quality regarding resident assessment/care plans; regularly auditing RAI process for accuracy, timeliness and submission; assisting with audits of MDS process with consultants and/or outside agencies; communicating results of internal and/or external audits to staff. 

Coordinates any record request to validate payment; including notification to the interdisciplinary team, development of checklist with dates of service documentation and mailing of the record in a timely manor.

Assists in developing and updating assessment and care plan policies and procedures to reflect the philosophy of the facility, professional standards, and legal requirements. 

Participates with Executive Director and/or Director of Nursing/designee in survey processes by: instructing staff regarding conduct and disclosure, reporting, being present at all times surveyors are on-site, directing prompt responses to requests for information, and undertaking corrective action, if appropriate. 

Maintains and applies current skills and knowledge through continuing education and in-service programs. 

Carries out responsibilities in compliance with federal, state, local laws and regulations, and with facility philosophy, policies and procedures. 

Ability to read and interpret technical journals, financial reports, and legal documents. Ability to respond to common inquiries or complaints from residents, regulatory agencies, or members of the business community. Ability to present information to management effectively. Must be able to speak, understand and read the English language to the extent necessary to safely and properly care for residents. 

Excellent interpersonal skills with high level of energy and enthusiasm. Ability to organize, document, and implement detailed programs. Good verbal and written communication skills. 

This position requires standing, sitting, stooping, pushing, pulling, lifting up to 75 pounds or more, bending, climbing, twisting upper body, walking, running, carrying, listening, talking, use of telephone, and exposure to medical equipment and persons with risk of illness. 

EDUCATION and/or EXPERIENCE:

Completion of registered nursing program. Experience with MDS, resident assessments, care plans and CAAs preferred. Meets state and federal requirements. 

CERTIFICATES, LICENSES, REGISTRATIONS:

nursing license per facility requirements.