Advantage Living Centers Communities MDS Coordinator in Roseville, Michigan
The purpose of the MDS Coordinator is to conduct and coordinate the development and completion of the RAI process. In addition, the MDS Coordinator oversees the process of clinical authorizations and assignment of reimbursement category for those residents covered under Managed Care or Insurance.
Registered Nurse with a minimum one year nursing experience in a skilled nursing/long-term care facility. Knowledge of Prospective Payment System (PPS) and Resident Assessment Instrument (RAI) processes preferred. Prior experience in Case Management and/or working with insurance companies preferred. Excellent verbal and written communication skills with residents, families, all levels of staff and external customers. Basic computer skills. Must possess the ability to work harmoniously with and supervise other personnel. Must possess a high degree of personal accountability, responsibility and the ability to make independent decisions when circumstances warrant such action. Must possess the ability to plan, organize, develop, implement, and interpret the programs, goals, objectives, policies, and procedures, etc., that are necessary for providing comprehensive activities to residents. Must commit to the Mission and Core Values of the organization. Essential Functions and Responsibilities
Coordinates assessment process, including completion of the Minimum Data Set (MDS) and the Care Area Assessments (CAAs). Manages timelines for RAI to ensure compliance with regulatory and facility requirements. Ensures integrity of the RAI process to produce clinical outcomes that reflect the needs and expectations of the residents at the facility. Conducts beside interview and assessment of residents prior to completing the MDS and CAAs to assure accurate assessments are completed and plans of care reflect the individual needs and preferences of the residents. Communicates with all relevant participants in the resident’s care to ensure expected outcomes and individualized plans of care are achieved. Coordinates and integrates resources to accomplish the care and plan and to evaluate progress/barriers to reaching desired outcomes. Encourages collaboration among interdisciplinary team members to ensure that clinical outcomes reflect the needs and expectations of the resident. Ensures that documentation in the health record reflects the RAI and care plan. Completes the Level of Care Determination accurately and timely for eligible residents. Develops a case management plan of care to address identified needs for in-hospital and post-hospital care. Works with insurance companies to obtain the clinical authorizations and documents information into the computer system. Works closely with admissions and the Business Office Manager to assure documentation needed for accurate assignment of insurance reimbursement categories occur. Provides education and leadership to the interdisciplinary team in regards to the RAI, PPS and care planning process. Monitors costs and resources for all ancillary and routine services for managed care and Medicare residents. Oversees the Medicare program to ensure compliance is maintained and certifications and re-certifications are timely. Oversees Managed Care residents to assure timely authorizations are obtained.