RN MDS Nurse, RAC Resident Assessment Coordinator

CommuniCare Health Services • Perry Heights, OH

7d

About The Position

Hanover Healthcare Center, a member of the CommuniCare Family of Companies, is currently recruiting for an RN MDS Nurse - Resident Assessment Coordinator to join our team. PURPOSE/BELIEF STATEMENT: The RN / LPN RAC (Resident Assessment Coordinator) reports to the Executive Director and is responsible for accurate and timely completion of MDS assessments and coordination of the RAI process. Provides Medicare, Medicaid (case mix), and managed care oversight to ensure appropriate clinical services are provided and appropriate reimbursement is received for each resident. This includes ensuring that the centers are in compliance with federal and state regulations as well as the CommuniCare Family of Companies’ guidelines and policies and procedures. This role serves as a key member of the facility’s management team in helping the facility obtain/maintain quality outcomes.

Requirements

• Graduate of an accredited school of nursing; RN
• Valid RN license in the state employed

Nice To Haves

• Three years of experience in a long term care environment preferred
• Experience with the MDS/RAI process and/or case management preferred

Responsibilities

• MDS scheduling and completion per RAI guidelines including coordinating care plan development and completion with the interdisciplinary team
• Develop an individualized, comprehensive resident care plan with the interdisciplinary team to ensure care area triggers are addressed
• Ensure care plans are reviewed quarterly and updated as needed to reflect current resident status with individualized problems, goals, and interventions
• Coordinate with other disciplines to ensure timeliness of assigned sections of MDS completion and report noncompliance to Executive Director
• Signature of MDS sections V0200B comprehensive CAA completion and Z0500A MDS completion
• Oversee clinical reimbursement and case management services within the center for Medicare A and B, managed care, insurance, and Medicaid (case mix)
• Direct and oversee the implementation of the CommuniCare family of companies programs, policies, and procedures related to the RAI process to ensure appropriate care is rendered and appropriate reimbursement is obtained
• Coordinate the timely and effective service delivery for all residents while ensuring quality clinical outcomes with appropriate reimbursement
• Advocate on behalf of the resident and facility for needed resident resources and services
• Provide education to other health care providers, the facility’s care team, and the resident/family on Medicare, Medicaid (case mix), managed care, and MDS completion
• Work as a liaison between the facility, the resident/family, rehabilitation, and other care providers
• Oversee and monitor MDS documentation and charting requirements that support services provided to meet billing requirements including state specific requirements for supportive documentation
• Provide oversight of the medicare and managed care residents, coordinate rehabilitation and optimal recovery, and assist with discharge planning
• Oversee the validation of Medicare entitlement and eligibility for prospective residents
• Complete chart audits to assess the quality of the documentation to support skilled Medicare, managed care, and Medicaid coverage
• Oversee the completion of certifications/recertifications
• Ensure Medicare part A and B services are appropriately billed and meet medicare documentation guidelines
• Oversee the resource utilization of services covered under consolidated billing as well as ancillary costs
• Direct the completion of requests for additional information claims requests and appeal for denied Medicare, managed care, and Medicaid claims
• Possess knowledge of facility managed care contract coverage guidelines, outliers, and contracts to ensure care is provided and billed appropriately
• Act as a liaison with the managed care plan provider to communicate resident needs while representing the interests of the facility and resident
• Ensure compliance with federal and state regulations, as well as the CommunCare Family of Companies’ policies and procedures regarding state specific case mix
• Participate in facility meetings per policy
• Oversee MDS accuracy and pertinent narrative data to support MDS assessment
• Perform other duties as assigned
• Conduct job responsibilities in accordance with the standards set in the code of conduct, policies and procedures, applicable federal and state laws, and applicable professional standards

Benefits

• As a CommuniCare employee you will enjoy competitive wages and PTO plans.
• we offer full time employees a menu of benefit options from life and disability plans to medical, dental, and vision coverage from quality benefit carriers.
• we also offer 401(k) with employer match and flexible spending accounts.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed