Care Management Specialist (CMS/MDS) - LVN (87019)

Regency Integrated Health Services•Bastrop, TX

7d•Onsite

About The Position

The Care Management Specialist (CMS/MDS) 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 resident's physical, mental, and psychosocial status and that appropriate documentation supports services provided and assessment accuracy. The specialist communicates effectively with the interdisciplinary team and adheres to all RIHS policies and procedures. The position manages the day-to-day operations of the department, maintains current knowledge of reimbursement regulations, and keeps data organized and easily retrievable. The role requires superior clinical assessment and documentation skills, strong interpersonal skills, and the ability to work effectively in a team environment. The specialist will also utilize local and corporate resources and may need to work flexible hours to support business requirements.

Requirements

Graduate of an accredited school of nursing with current R.N. or L.V.N. licensure.
Licensure in the state in which employment occurs.
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.
Competency with software applications related to MDS/RAI processes.
High initiative and ability to efficiently and effectively lead interdisciplinary teams.
Ability to coordinate and manage the RAI process.
Minimum of two years health care experience.
Must possess superior clinical assessment and documentation skills.
Must demonstrate strong interpersonal skills.
Ability to work well in a team environment.
Excellent verbal and written communication and presentation skills.

Nice To Haves

Experience with MDS completion, reimbursement, clinical resource utilization and/or case management is highly desirable.
Specific job functions denoted by "" will require an RN to Coordinate the process as stipulated by Federal Regulations.

Responsibilities

Coordinate the Resident Assessment Instrument (RAI) process for accurate and timely completion of resident assessments.
Ensure assessments accurately reflect the resident’s physical, mental, and psychosocial status.
Ensure appropriate documentation to report and support services provided and assessment accuracy.
Communicate effectively with other members of the interdisciplinary team.
Follow all RIHS policies and procedures.
Ensure timely, accurate, and complete assessment of the resident’s health and functional status.
Participate in the pre-admission process to obtain essential information for MDS/Case Mix optimization.
Ensure accurate and timely completion of Medicare/Medicaid case-mix documents for appropriate reimbursement.
Collaborate with the facility Director of Rehab to ensure the most appropriate assessment reference date (ARD) is utilized for Medicare/Managed Care Assessments.
Track Skilled (MRA/MCO/MCG/MMP) customers using Case Management Tools to determine continued and appropriate Medicare/Managed Care eligibility and benefit period.
Gather information needed for Managed Care Utilization Reviews and communicate with the Managed Care organization’s Case Manager.
Ensure that additional requirements of the Medicare Program, such as Physician certification and re-certification, are met.
Perform concurrent MDS review to assure appropriate RUGs category is achieved.
Participate in the interdisciplinary team process to communicate opportunities and facilitate efficient care plan development and management.
Ensure the accurate and timely completion of all MDS assessments (PPS, Unscheduled, Admission, Quarterly, Annual, and Significant Change).
Collaborate with the interdisciplinary team to identify significant changes in status and implement Significant Change in Status MDS.
Maintain an accurate schedule of all MDS assessments and reference dates.
Track, record, and analyze all default days and rectify if appropriate.
Implement corrective action to prevent further default action.
Perform Modification/Inactivation of assessments in accordance with CMS Correction Policy.
Conduct regular audits of the MDS process, including validation of coding documentation and evaluation of outcomes.
Ensure the timely electronic submission of all Minimum Data Sets and secure back-up personnel.
Review Validation reports and ensure appropriate follow-up action is taken.
Review Late/Missed assessment reports monthly and address issues.
Review QM and SNF QRP reports monthly and ensure appropriate follow-up action is taken.
Communicate with the Business Office Manager and Administrator regarding RUG distribution, default days/unassigned days, case mix index, and their reimbursement impact.
Participate in daily Case Management, weekly Level of Care, monthly Triple Check, and other meetings.
Assist in the preparation and timely submission of any Additional Development Requests (ADRs), Reconsideration, and Administrative Law Judge (ALJ) requests.
Function as an RAI and Care Management resource to facility staff.
Utilize AIS for annual competency training and as an educational resource.
Assist in the orientation and training of new associates on the RAI process.
Ensure dissemination of new or updated materials regarding RAI and/or Federal and State regulations.
Maintain current knowledge of reimbursement regulations.
Maintain data in an organized, easily retrievable manner.
Maintain good personal hygiene and follow dress code requirements.
Communicate 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.
Other duties as assigned or needed.