Responsibilities/Duties:

Meet with resident care givers/families to discuss the residents condition and treatment plans

Records data from residents medical chart

Provide daily input with IDT, as needed by the facilities in regards to MDS functions and clinical needs.

Continuous up to date data to care plans to ensure care for resident is transcribed and up to date

Provides information for insurance and auth request

Attends meetings as scheduled, which includes, but not limited to daily stand up/start up, High Risk, care plan meeting, MCR, triple check, QA, etc. Attends trainings as scheduled

Observes and completes sig changes related to resident to ensure quality of care is met and appropriate for resident

Follows resident days of treatment and therapy/nursing skilled that res enters with and keeps track of required certs/auths/etc.

Reviews with IDT monthly for compliance, review to make sure MDS assessments completed and closed according to guidelines, review and verify isolation coding with billing.

Coordinate services with insurance companies for cost analysis and reimbursement as needed.

Assist in Medicare Advantage/HMO authorizations as needed.

MDS scheduling for both Medicare and Medicaid with the facilities as needed.

Review and ensure compliance with Medicare Certification and Recertification for skilled residents.

Coordinate services with Therapy company to ensure Skilled guidelines and Part B guidelines are followed and coding is completed accordingly.

Completes Scheduled/sig change/Quarterly review of transmissions to ensure accurate transmit status and coding.

Provides on-site and off-site assistance with State Survey.

Performs other related duties as assigned.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Job Description

1. Knowledge of current RAI guideline updates, CMS updates and Regulatory standards relevant to Skilled and Long-Term Care Nursing.

2. Demonstrates leadership and managerial ability.

3. Has the ability to organize, plan, and supervise care.

4. Maintains effective interpersonal relationships.

5. Is of good emotional, mental, and physical health, having sound judgment and high professional standards.

6. Must be willing and capable of providing emergency assistance to residents as indicated.

7. Is courteous in working with residents, families, and employees.

8. Maintains a neat, well-groomed and professional appearance at all times.

9. Has a desire to work with the geriatric resident and their current and prospective needs.

10. Must be willing to perform in-site and off-site facility reviews.

11. Must demonstrate ability to evaluate the geriatric resident’s needs and provide intervention timely to assure each resident’s needs are met.

12. Must demonstrate ability to evaluate nursing staff needs and provide staff education timely to provide quality care.

13. Must demonstrate ability to function as a cooperative team member with each member of the Nursing Department and other departments.

14. Must demonstrate the ability to follow and supervise assigned staff to assure the facilities policies and procedures are followed and upheld.

15. Must demonstrate the ability to manage and supervise the assigned unit in a productive, timely manner.

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to stand, walk, use hands to finger, handle or feel, reach with hands and arms, stoop, kneel, crouch or crawl, and talk or hear. The employee frequently is required to climb or balance. The employee must frequently lift and/or move up to 50 pounds.

Job Location:

Must work throughout the nursing areas of the facility. May require working irregular hours and may be exposed to communicable diseases and/or body fluids, medical preparations, toxic substances and occasionally ionizing radiation. Must be able to travel to all assigned facilities.

Working Conditions

1. Works in office area(s) as well as throughout the nursing service area (i.e., drug rooms, nurses’ station, resident rooms, etc.).

2. Moves intermittently during working hours.

3. Is subject to frequent interruptions.

4. Is involved with residents, personnel, visitors, government agencies/personnel, etc., under all conditions/circumstances.

5. Is subject to hostile and emotionally upset residents, family members, personnel, visitors, etc.

6. Communicates with the medical staff, nursing personnel, and other department directors.

7. Works beyond normal working hours, and in other positions temporarily, when necessary.

8. Is subject to callback during emergency conditions (i.e., severe weather, evacuation, post-disaster, etc.).

9. Is involved in community/civic health matters/projects as appropriate.

10. Attends and participates in continuing educational programs.

11. Is subject to injury from falls, burns from equipment, odors, etc., throughout the workday, as well as reactions from dust, disinfectants, tobacco smoke, and other air contaminants.

12. Is subject to exposure to infectious waste, diseases, conditions, etc., including TB and the HIV and Hepatitis B viruses.

13. May be subject to the handling of and exposure to hazardous chemicals.

14. Maintains a liaison with the residents, their families, support departments, etc., to adequately plan for the resident’s needs.

Education:

Must possess, as a minimum, a Nursing Degree from an accredited college or university, or be a graduate of an approved LPN/RN program.

Specific Requirements:

1. Must possess a current, unencumbered, active license to practice as an RN or LPN/LVN in areas assigned.

2. Must be able to read, write, speak, and understand the English language.

3. Must demonstrate knowledgeable skills necessary to provide care appropriate to the age-related needs of the residents served.

4. Must be a supportive team member, contribute to and be an example of team work and team concept.

5. Must possess the ability to make independent decisions when circumstances warrant such actions.

6. Must possess the ability to deal tactfully with personnel, residents, family members, visitors, government agencies/personnel and the general public.

7. Must be knowledgeable of nursing and medical practices and procedures, as well as laws, regulations, and guidelines that pertain to nursing care facilities.

8. Must possess leadership and supervisory ability and the willingness to work harmoniously with and supervise other personnel.

9. Must possess the ability to plan, organize, develop, implement, and interpret the programs, goals, objectives, policies and procedures, etc., that are necessary for providing quality care.

10. Must have patience, tact, cheerful disposition and enthusiasm, as well as must be willing to handle difficult residents.

11. Must be willing to seek out new methods and principles and be willing to incorporate them into existing nursing practices.

12. Must be able to relate information concerning a resident’s condition.

13. Must not pose a direct threat to the health or safety of other individuals in the workplace.

Physical and Sensory Requirements:

(With or without the aid of mechanical devices)

1. Must be able to move intermittently throughout the workday.

2. Must be able to speak and write the English language in an understandable manner.

3. Must be able to cope with the mental and emotional stress of the position.

4. Must be able to see and hear or use prosthetics that will enable those senses to function adequately so the requirements of this position can be fully met.

5. Must function independently, have flexibility, personal integrity, and the ability to work effectively with residents, personnel, and support agencies.

6. Must meet the general health requirements set forth by the policies of this facility, which includes a medical and physical examination.

7. Must be able to relate to and work with ill, disabled, elderly, emotionally upset, and at times, hostile people within the facility.

8. Must be able to push, pull, move and/or lift a minimum of 25 pounds to a minimum height of 5 feet and be able to push, pull, move and/or carry such weight a minimum distance of 50 feet.

9. May be necessary to assist in the evacuation of residents during emergency situations.

10. Must be able to utilize the computer programs required to perform the job function.