Avalon Health Care is seeking an experienced MDS Nurse to join our team as a Resident Assessment Director !
The Resident Assessment Director will be the lead department position. In this position the Director will be responsible for all of the facility Medicare and Managed Care residents. This will include the oversight of all service provided during inpatient stay from admission to discharge. This position is also responsible for the accurate and timely completion of all OBRA required assessments. This role is viewed as a key financial and clinical member of the management team. This position will not be subject to nursing “call” schedules.
Essential Duties and Responsibilities:
Works with direction from the Regional Resident Assessment Director.
Works in collaboration with the Interdisciplinary Team to assess the needs of the resident
Participates in the pre-admission process to ensure essential information, needed for MDS/Case Mix optimization, is obtained from the referral source(s).
Assists the Administrator in coordinating the daily PPS Management meeting, to include review of resident care and the setting of the Assessment Reference Date in collaboration with the Facility Rehab Coordinator to ensure the most appropriate assessment reference date (ARD) is utilized for Medicare Assessments
Ensures accurate and timely Resident Assessments according to state and federal regulations
Designates responsibility for completing sections of the assessment to the interdisciplinary team
Completes accurate coding of the MDS with information obtained from interviews with facility staff, resident, and family members as well as observation of the resident and medical record review.
Maintains the MDS schedules in the computer.
Maintains the frequent and accurate data entry of resident information into appropriate computerized MDS programs
Obtain, review and maintain all State and Federal reports, making appropriate corrections timely in communication with the Regional Resident Assessment Director.
Coordinates the electronic submission of required documentation to the QIES ASAP database and other entities per Avalon Guidelines and State and Federal regulations
Completes required forms and documents in accordance with Avalon Guidelines and state and/or federal regulations ·
Participates in quality assurance activities
Monitors daily: Skilled nurse’s notes and ADL flow records.
Provides education to staff based on the findings of the notes and ADL sheets and coordinates education related to the RAI/Care Management process for the facility
Responsible for communicating any changes in resident’s condition to the managed care external Case Manager, and negotiates level of care changes as well as any equipment and discharge needs.
Performs Modifications/Inactivation’s of assessment in accordance to CMS Correction Policy and in communication with the Regional Resident Assessment Director.
Tracks, records and analyzes all defaults and rectifies if appropriate in communication with the Regional Resident Assessment Director. Implements corrective action to prevent further default status.
Reviews quarterly State CM Resident rosters for accuracy. Corrects any inaccuracies in a timely matter.
Maintains a current knowledge base regarding State and Federal Regulations, PPS and the RAI Process.
Manages Medicare Part A and B certification/recertification process.
Performs ongoing evaluation from pre-admission through discharge to ensure an appropriate reimbursement level for each resident. Evaluates care to ensure that services and products provided match benefits available.
Reviews medical records, care plans, charting to ensure documentation supports care provided and reimbursement level.
Monitors facility practice to ensure compliance with guidelines for participation in Medicare, Medicaid and other benefit programs. Initiates action needed to ensure compliance.
Participates in triple check prior to releasing claims
Coordinates Additional Development Requests (ADRs), Reconsiderations and Administrative Law Judge (ALJ) hearings in communication with the Regional Resident Assessment Director.
Tracks and reviews all claims denials to identify problems. and implement processes to prevent future denials in communication with the Regional Resident Assessment Director
Reviews MDS validation reports to identify issues and/or processes to ensure accuracy of submitted MDS.
Communicates regularly with Regional Resident Assessment Director to identify clinical reimbursement issues.
Our post-acute facilities are physician-led, quality-driven, and patient-centered. This patient focus and standard of care allows our employees to build long term, meaningful relationships with our patients. That is why Avalon employees proudly say “We embrace a reverence for life and a heart for healing.”
We are looking for like-minded individuals who welcome responsibility and are excited to uphold our core principles. With enthusiasm and compassion, our Avalon family works with our patients and their families as well as with our communities to celebrate life every day!
If you seek to use your mind and your heart to improve lives on a daily basis, come join our team! We offer great challenges and opportunities for personal fulfillment!
Must have a current, active license to practice as a Registered Nurse (RN) in State of practice..
Must be well-versed in inter-personal communications
Must be familiar with the RAI process and Case Management
Two (2) years experience in a social or recreational program.
Avalon Health Care - 2 years ago