Mds Care Plan Coordinator

Helia Healthcare•Yorkville, IL

8d•Onsite

About The Position

The MDS Care Plan Coordinator manages the integrity of the facility’s RAI and Medicare processes. The role ensures that residents receiving Medicare services qualify for them, required continuing-stay documentation is completed, MDS/PPS assessments are timely and accurate under applicable regulations, and skilled nursing care continues as appropriate. The coordinator works with residents, families, the interdisciplinary team, nursing staff, and facility leaders to coordinate assessments, care plans, Medicare documentation, and related processes. The position also supports Medicaid reimbursement documentation, monitors regulatory updates, submits and corrects MDS assessments, and helps ensure accurate Medicare billing and coverage communications. The coordinator may assist with treatments, medications, and nursing services as needed, is required to be on call as needed, and participates in staff education and orientation. This role is based in a nursing home facility. It requires frequent standing and walking, occasional sitting and other hand, arm, communication, and sensory activities, and occasional lifting or moving of up to 50 pounds. The employee may occasionally be exposed to blood or other body fluids, fumes or airborne particles, and toxic or caustic chemicals. The work environment generally has moderate noise.

Requirements

Current, valid state nurse license.
Functional literacy in English, including the ability to communicate by phone, in writing, and verbally with staff, patient families, and outside customers.
Proficiency in computer use and data entry.
No disqualifying criminal offenses as defined by regulatory guidelines.
Ability to use a computer and phone for extended periods.
Ability to occasionally lift and/or move up to 50 pounds.

Nice To Haves

Education and/or experience in long-term care, acute care, or geriatric nursing.
MDS/RAI experience.

Responsibilities

Obtain and maintain timely physician certifications for each Medicare resident.
Coordinate preparation of MDS assessments and care plans according to regulatory requirements, and update care plans as needed.
Maintain the MDS care plan schedule for the interdisciplinary team, invite residents and families to care plan meetings, and assist residents in attending those meetings.
Ensure daily assessment documentation is completed for each Medicare resident and verify it meets Medicare coverage guidelines.
Track Medicare benefit days, validate the daily Medicare census, and coordinate information with the Business Office Manager to support accurate billing.
Coordinate weekly Medicare meetings with the interdisciplinary team.
Work with the Social Service Director to keep residents and responsible parties informed about continuing or ending Medicare coverage.
Respond to intermediary requests for additional information and complete appeals decisions within established time frames, when necessary.
Ensure Medicare denial letters are prepared for residents discharged from Medicare coverage within applicable time limits.
Participate in ongoing evaluation of documentation required for Medicaid reimbursement.
Monitor the appropriate MDS website for updates.
Submit MDS assessments to E-Health for analysis and correct them as needed.
Transmit assessments to the state repository according to regulatory guidelines, review validation reports, correct errors, and resubmit assessments as needed.
Monitor nursing personnel’s compliance with Dart Chart documentation and maintain a RUG variance rate below 2% compared with DART Chart System Calculations.
Function as a team leader and role model.
Ensure the attending physician and family or responsible party are promptly notified of significant changes in a resident’s health condition.
Know and enforce responsibilities under the abuse prevention policy.
Assist with treatments, medications, and nursing services as needed.
Be on call as needed by the facility.
Participate in ongoing staff education and orientation.
Support the Director of Nursing and Assistant Director of Nursing by ensuring nursing staff follow facility policies and procedures.