Care Management Nurse- LVN (85420)

Regency Integrated Health Services•Houston, TX

3d•Onsite

About The Position

The Care Management Nurse- LVN is 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. This role ensures assessments accurately reflect the physical, mental, and psychosocial status of each resident and that appropriate documentation supports services provided and assessment accuracy. The position requires effective communication with the interdisciplinary team and adherence to all RIHS policies and procedures.

Requirements

Must be a graduate of an accredited school of nursing with current RN or LVN.
Complete and pass all RIHS specific MDS/RUGs training modules (AIS) 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.
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.

Nice To Haves

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

Responsibilities

Ensures timely, accurate, and complete assessment of the resident’s health and functional status.
Participates in the pre-admission process to obtain essential information for MDS/Case Mix optimization.
Ensures accurate and timely completion of Medicare/Medicaid case-mix documents for appropriate reimbursement.
Works with the Director of Rehab to ensure the most appropriate assessment reference date (ARD) for Medicare/Managed Care Assessments.
Tracks Skilled (MRA/MCO/MCG/MMP) customers using Case Management Tools to determine continued and appropriate Medicare/Managed Care eligibility and benefit period.
Gathers information for Managed Care Utilization Reviews and communicates with the Managed Care organization’s Case Manager.
Ensures additional Medicare Program requirements, such as Physician certification and re-certification, are met.
Performs concurrent MDS review to assure appropriate RUGs category through capture of appropriate clinical information.
Participates in the interdisciplinary team process to communicate opportunities and facilitate care plan development and management.
Ensures accurate and timely completion of all MDS assessments (PPS, Unscheduled, Admission, Quarterly, Annual, Significant Change) in compliance with RAI guidelines.
Collaborates with the interdisciplinary team to identify significant changes in status and implement Significant Change in Status MDS.
Maintains an accurate schedule of all MDS assessments with proper reference dates.
Tracks, records, and analyzes all default days and rectifies if appropriate, implementing corrective action to prevent further default action.
Performs Modification/Inactivation of assessments in accordance with CMS Correction Policy and collaboration with Regional Care Management Specialist.
Conducts regular audits of the MDS process, including validation of coding documentation, evaluating outcomes, and utilization of Data Integrity Audit reports.
Ensures timely electronic submission of all Minimum Data Sets and secures back-up personnel.
Reviews Validation reports and ensures appropriate follow-up action is taken.
Reviews Late/Missed assessment reports monthly and addresses issues.
Reviews QM and SNF QRP reports monthly and ensures appropriate follow-up action is taken.
Communicates with the Business Office Manager and Administrator regarding RUG distribution, default days/unassigned days, case mix index, and their reimbursement impact.
Participates in daily Case Management, weekly Level of Care, monthly Triple Check, and other meetings per RIHS policy.
Assists in the preparation and timely submission of any Additional Development Requests (ADRs), Reconsideration, and Administrative Law Judge (ALJ) requests.
Functions as an RAI and Care Management resource to facility staff.
Utilizes AIS for annual competency training and as an educational resource.
Assists in the orientation and training of new associates on the RAI process and ensures dissemination of new or updated materials regarding RAI and/or Federal and State regulations.
Manages the day-to-day operations of the department.
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 Regional Care Management Specialist to discuss identified clinical reimbursement issues.
Ability to work flexible work hours to support business requirements.
Ability to utilize both local and corporate resources.
Must possess superior clinical assessment and documentation skills.
Must demonstrate strong interpersonal skills and ability to work well in a team environment.
Other duties as assigned or needed.