Signature Healthcare of Methodist, LLC, a 20-bed skilled nursing facility within a hospital setting. Highly skilled professionals are dedicated to providing the highest level of care to each individual. The majority of skilled residents are able to return home.
Conduct and coordinate the development and completion of the resident assessment process in accordance with the requirements of the Federal and State regulations as well as Company policy and procedure.
Essential Duties & Responsibilities:
- Oversee and coordinate the development and completion of the resident assessment (MDS) in accordance with current Federal and State rules, regulations, and guidelines that govern the resident assessment, including the implementation of RAPs and Triggers.
- Assemble information from the Initial Nursing Assessment, resident interview, and clinical record review to complete the nursing portion of the Minimum Data Set.
- Notify all members of the interdisciplinary team of MDS schedule for Medicare and OBRA Assessments.
- Monitor and follow-up with team members as needed to verify that all assigned sections of the MDS are completed, dated, and signed within designated time frames.
- If a member of the interdisciplinary team is absent during the time frame for completion of a MDS, conduct necessary research and referral to confirm that all MDS sections and triggered RAPs are completed.
- Review each MDS for accuracy, consistency, completeness, and signatures.
- Verify that MDS documentation is placed in resident’s medical record and that documentation is complete, including dates, signatures, and sections completed by all members of the interdisciplinary team. Complete, date, and sign MDS quarterly review sheets.
- Verify the face validity of all Minimum Data Sets before electronic submission.
- Participate in and oversee the timely electronic submission of all MDS.
- Review the validation report and verify that appropriate action is taken to correct errors and warnings.
- Review the Resident Assessment Protocols correlated with nursing issues and answer the questions as identified in the computer documentation system. Once all the questions have been answered complete narrative summaries of the information, indicating the decision whether or not to include the identified problem on the Plan of Care.
- Consult the RAP summary sheet and verify that all triggered RAPs and corresponding narrative summaries have been completed, dated, and signed by the appropriate disciplines.
- For triggered RAPs included in the Care Plan, verify that any additional supportive documentation related to RAP issues is completed.
- If a triggered RAP is not included in the Care Plan, verify that documentation in the RAP summary clearly indicates reasons for not proceeding.
- Schedule interdisciplinary care plan meetings, and notify staff in advance which residents will be evaluated.
- Identify and document nursing problems, goals, and approaches, and coordinate the development of an individual Plan of Care for each resident in cooperation with the physician, Medical Director, nursing staff, interdisciplinary team, and outside consultants (nursing, dietary, pharmacy, therapists, etc.) in accordance with corporate, state, and federal guidelines.
- Correlate the information to update resident care plans quarterly and after each significant change. Verify that all updates are completed. Generate final copy, and verify that signatures from the physician, interdisciplinary team, and contributing resident or family members are obtained.
- Case Manage Medicare Part A patients.
- Disseminate any new or updated materials involving the RAI process.
- Participate in triple check meeting at least monthly
- Coordinate the interdisciplinary assessment process for all residents of the facility. Verify that the Resident Assessment Instrument is individualized, complete, accurate, and timely for each resident.
- Conduct and facilitate the Interdisciplinary Care Plan meetings. Educate peers on MDS, RAPs, and Care Plans.
- Other special projects and duties, as assigned.
Signature HealthCARE LLC. - 17 months ago