RAI Director

Presbyterian Homes & Services•Roseville, MN

8d•$81,598 - $101,982•Hybrid

About The Position

Presbyterian Homes & Services is seeking an RAI Director to join our team. The RAI Director is a regional role that is responsible for coordinating and overseeing the development and completion of the resident assessment process consistent with regulations and established clinical best practices across PHS designated care centers. This position is hybrid, with on-site visits to assigned communities.

Requirements

Registered nurse with current licensure the State Board of Nursing in state(s) in which he/she practice
Previous long-term care experience with a working knowledge of the RAI process
Experience with MDS completion, reimbursement, clinical resource utilization and/or case management
Ability to work flexible work hours to support business requirements
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
Demonstrated compatibility with PHS's mission and operating philosophies
Demonstrated ability to read, write, speak and understand the English language to communicate with all customers.

Responsibilities

Hire, train and manage the performance of the MDS Nurses in your assigned region.
For your assigned region, direct and ensure the development and completion of the resident assessment process with other health professionals consistent with regulations and established clinical best practices. Ensure timely, accurate and complete assessment of the resident’s health and functional status during the entire assessment period.
Ensure that an accurate schedule and assignments of all MDS assessments to include the proper reference dates throughout the resident’s stay is maintained by the assigned MDS Nurse.
Audit PDPM grouper/MDS end splits, review all expedited appeals and ALJ level appeals. Perform concurrent MDS review to assure appropriate category is achieved through the capture of appropriate clinical information.
Perform monthly QI/QM review for assigned region and provide recommendations to site administrator/IDT and MDS Nurses.
Complete triple check for assigned region (Review UB04’s for clinical billing), review ancillary service charges.
Determine denials/communications at IDT, track residents in 30 day window, monitoring regulatory compliance for completion.
Participate in the interdisciplinary team process (IDT) to communicate opportunities, facilitate efficient and effective care plan development and management for your assigned region. Specifically communicate (but not limited to): Medicare/Medicare Advantage admissions, changes to skilled services, PPS scheduled assessment ARDs, significant change in status assessments, PPS unscheduled assessment ARDs, Medicare beneficiary and Medicare Advantage Plan notices.
Prepare and lead functional work group for your team.
Maintain knowledge of all MDS based QRP/Quality Measures and work to address 5-star Quality Measures consistent with PHS guidelines.