Job Description

Job Description

Position Summary :

Conduct and/or manage the assessment processes for establishing Plans of Care for each Skilled Nursing and Long-Term Care (LTC) resident; interpret and implement Centers for Medicare and Medicaid Services (CMS) regulations assuring the highest quality of resident services and comprehensive and accurate billing for services are achieved.

Essential Functions :

Utilize the current RAI Manual as a resource during the assessment coding process.

Schedule the Assessment Reference Dates (ARDs) for payment assessments in a manner that accurately captures each resident's clinical characteristics for payment classification purposes.

Schedule the ARDs for all Omnibus Budget Reconciliation Act (OBRA) assessments daily, monthly, and as needed.

Provide a schedule of ARDs and assessment types weekly and as needed to the interdisciplinary team (IDT) in order to facilitate the timely completion of MDS sections and Care Area Assessments (CAAs) by each discipline.

Communicate with members of the IDT, as needed, for timely completion of assessments. Report any issues with timeliness to the Administrator.

Transmit assessments in accordance with current regulations. Facilitate timely receipt of validation reports. Transmit as frequently (daily) as necessary to obtain timely validation of MDS acceptance into the Quality Improvement and Evaluation System (QIES) Assessment Submission and Processing (ASAP) System data base.

Confirm transmission files by review and print initial and final validation reports.

Correct any fatal errors immediately and retransmit the assessment until an accepted validation report is received.

Facilitate the completion and update of resident care plans with the IDT to reflect each resident's current needs.

Communicate with the IDT to identify residents in need of a Significant Change in Status assessment, based on criteria in the current RAI manual.

Participate in all resource utilization and/or triple check meetings prior to billing of claims associated with payment assessments.

Review all Casper reports and reconcile Montereau quality indicators with national service trends, by investigating gaps and initiating solutions for service delivery with any/all Montereau service areas to lead quality improvement and quality assurance initiatives relating to MDS. Provide direct feedback and/or training to care givers or supervisors to enhance the quality of services to the residents and reimbursements to Montereau.

Other Functions :

Visit with resident family members to help clarify billing and service issues.

Attend or participate in continuing education related to the RAI process and related programs. Complete all assigned training and skills competency, as determined by the facility assessment and facility training plans.

Participate in the Nurse Manager On-Call rotation to support Nurse Care Partners with critical resident care decisions and assure adequate staffing and scheduling.

Performs administrative duties as assigned, including but not limited to QAPI, SOC, and participation in department or committee meetings.

Work care base shifts, as needed, to assure proper resident care is provided.

If necessary, participate in the Manager on Duty (MOD) rotation.

Perform other related functions as required or as assigned.

Position Requirements :

Experience:

A minimum of 1 year experience as a Registered Nurse/LPN working in a leadership capacity within a LTC facility that is Medicare or Medicaid certified using CMS service billing systems is preferred
Previous quality assurance/quality improvement experience is preferred

Education/Certifications/Licenses:

Current State of Oklahoma Registered Nurse/LPN license, , is required
Resident Assessment Coordinator Certification (RAC-CT) is required, or must receive certification within 1 year
Current CPR and First Aid certification is required

Job Specific Knowledge, Skills, and Abilities:

· Proficient knowledge of ICD coding and billing

- Strong knowledge related to establishing and following care plans
- Working knowledge of Microsoft Office programs and ability to learn new software systems (i.e. MatrixCare)
- Ability to work a variety of shifts (days, evenings, nights, weekends), when needed

- Solid problem solving and decision making skills
- Strong communication skills to effectively and empathetically address critical health and death issues with a diverse resident population and family members

Strong interpersonal skills and understanding of quality customer management and service
Ability to effectively interact with a diverse leadership team, team members, residents, and third-party associates, including vendors, providers, and visitors
Ability to effectively manage sensitive and confidential communications and information, while maintaining a high level of poise, tact, and diplomacy

Physical Demands:
In order to accomplish the essential functions of this position, the following are required:

An extensive amount of walking, standing, and sitting, with a moderate amount of bending at the waist, kneeling, twisting/turning, reaching above the head and shoulders, and eye-hand coordination
- Ability to routinely lift 35 pounds and push wheelchairs with loads of up to 300 pounds
- Frequent use of ordinary communication, including normal levels of hearing and vision, including both near and far seeing, color discrimination, field of vision, and depth perception
- Ability to use a computer or other office equipment for an extensive period of time
- Ability to occasionally travel by car and/or commercial airline
Working Conditions:
This position is performed primarily indoors in a climate-controlled setting within both a shared office environment and in a skilled nursing resident environment with occasional exposure to high noise levels (alarms).
Mental and Emotional Requirements:
This position requires:
- Understanding and carrying out oral and written instructions and reviewing/preparing detailed reports, schedules and medical records, using measuring devices and simple calculations
- Planning own work activities and occasionally directing and training others in their work assignments
- Working independently or as a member of a team, and the ability to work with limited supervision
- Routinely working on multiple tasks at the same time, under moderate amounts of pressure for results, with frequently changing priorities and requirements for extreme accuracy
Safety/Security Requirements:
- Must successfully pass a pre-employment drug test
- Must successfully pass a criminal background screening
- Must successfully pass a tuberculosis (TB) screening test
- Must comply with Montereau's Influenza Prevention and Vaccine Policy
- Must comply with Montereau's Covid-19 Vaccine Policy
Nothing in this position description restricts management's right to assign or reassign duties and responsibilities to this job at any time.
This document does not create an employment contract, implied or otherwise, other than an "at-will" employment relationship.
Incumbent Acknowledgement : I acknowledge that I have read this Position Description and can perform the Essential Functions as described without accommodation. I understand that should I require accommodation now or in the future, I should make a request by following the procedures outlined in the Montereau Employee Handbook.

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