CARE MANAGEMENT SPECIALIST (72725)

Regency Integrated Health Services • Brownsville, TX

254d

About The Position

The Care Management Specialist 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 that assessments accurately reflect the physical, mental, and psychosocial status of each resident and that appropriate documentation is provided to support services and assessment accuracy. Effective communication with other members of the interdisciplinary team is essential. The position requires adherence to all RIHS policies and procedures.

Requirements

• Must be a graduate of an accredited school of nursing with current R.N. or L.V.N.
• Complete and pass all RIHS specific MDS/RUGs training modules within the first 90 days of employment.
• Competency with standard office software applications and MDS/RAI related software.
• 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

• Strong interpersonal skills and ability to work well in a team environment.
• High initiative and ability to efficiently lead interdisciplinary teams.

Responsibilities

• Ensure timely, accurate, and complete assessment of the resident's health and functional status during the entire assessment period.
• Participate in the pre-admission process to obtain essential information for MDS/Case Mix optimization.
• Ensure accurate and timely completion of all Medicare/Medicaid case-mix documents.
• Collaborate with the facility Director of Rehab for appropriate assessment reference dates.
• Track Skilled customers utilizing Case Management Tools for Medicare/Managed Care eligibility.
• Gather information for Managed Care Utilization Reviews and communicate with Case Managers.
• Ensure compliance with additional Medicare Program requirements.
• Perform concurrent MDS review to achieve appropriate RUGs category.
• Participate in interdisciplinary team processes for care plan development.
• Maintain an accurate schedule of all MDS assessments.
• Track, record, and analyze all default days and implement corrective actions.
• Conduct regular audits of the MDS process and ensure timely electronic submission of all Minimum Data Sets.
• Review Validation reports and ensure appropriate follow-up actions.
• Communicate regularly with the Business Office Manager and Administrator regarding RUG distribution and reimbursement impact.
• Participate in daily Case Management and other meetings as per RIHS policy.
• Function as an RAI and Care Management resource to facility staff.
• Assist in the orientation and training of new associates on the RAI process.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Nursing and Residential Care Facilities
• Education Level: Bachelor's degree