Provides assistance in resident assessment activities including the MDS and Care Planning process in multiple facilities. Provides audit and training support to the Regional CMS role. Ensures compliance with federal and state regulations, as well as company policy and procedures regarding state Case Mix/Medicare and Managed Care payment systems.
This person will support facilities in our West region to include: Eagle Pass, Del Rio, Seguin, San Antonio, Yoakum, Boerne, Cuero, Pearsall, and George West.
- Provides training and support concerning the Medicare, Managed Care and state Case Mix payment systems for the assigned area.
- Ensures the timeliness and accuracy of MDS information.
- Ensures the submission and transmission of information meets requirements of company and regulatory agencies.
- Coordinates the MDS and Care Planning process with the facilities assigned and travels to assigned facilities as needs dictate.
- Recognizes, advises, and promotes facility best practices and systems for dealing with state Case Mix/Medicare, and Managed Care payment systems.
- Works in conjunction with regional teams to resolve issues effecting deviations from expected results.
- Regularly communicates with Regional CMS on recommendations made to facility management to ensure proper implementation and follow-up.
- Attends state sponsored Case Mix training as indicated.
- Attends regional meetings, as well as company conference calls and trainings as appropriate.
- Works with regional team to coordinate training to facility team members on state Case Mix/Medicare/Managed Care payment systems.
- Identifies facility and regional education needs and provides small/large group and individual training as needed.
- Participates in daily Case Management, weekly Level of Care meeting, monthly Triple Check and other meetings per RIHS policy.
- Functions as an RAI and Clinical Reimbursement resource to the facility staff.
- Other Duties
- Maintains current knowledge of reimbursement regulations.
- Maintains data in an organized, easily retrievable manner.
- Maintains good personal hygiene and follows dress code requirements.
- Communicates regularly with the Regional Care Management Specialist and Director of Care Management to discuss identified clinical reimbursement issues.
- Other duties as assigned or needed.
- RN/LVN/Therapist or completion of a Bachelor’s Degree in a health care or related field, consistent with the duties to be performed.
- Three to five years of clinical experience in a long term care setting.
- Current knowledge of computer technology and systems.
- Ability to work independently with minimal supervision and guidance.
- Proven written and oral communication skills.
- Proven decision making and analytical skills.
- Extensive knowledge of MDS and back-up documentation required and extensive knowledge of state grouper and calculator field relative to MDS and state payment.
- Extensive knowledge of Medicare reimbursement, RUG IV system, compliance and eligibility.
- Must be willing and able to travel extensively and maintain a valid driver’s license.
- Basic understanding of rehab, dietary, social services, and recreational services.
- Must meet all local health regulations and pass post-employment physical exam, if required.
- Must be capable of performing the Essential Job Duties of the job, with or without reasonable accommodation.
- Competency in computer technology and systems needed to manage Medicare/state Case Mix systems.
- Competency with standard office software applications as well as software applications related to MDS/RAI processes.
- Analytical reasoning
- Logical reasoning
- Problem solving
- Time management
- Organizational skills
- Research skills
- Must possess excellent verbal and written communication and presentation skills. This is occasionally heavy work requiring a combination of sitting, walking, climbing stairs, and standing. Moderate use of both upper and lower extremities is necessary for ambulation and equilibrium and carrying objects weighing 75 pounds. Heavy use of arms, hands, and fingers. Intact visual, auditory, and verbal capabilities are essential. Pulls, pushes, lifts and carries a minimum of 75 pounds using proper body mechanics. Performs repetitive/continuous tasks.
- Must possess superior clinical assessment and documentation skills.
- Must demonstrate strong interpersonal skills and ability to work well in a team environment.
Regency Integrated Health Services is an EEO employer - M/F/Vets/Disabled