MDS Care Plan Coordinator
River Valley Rehabilitation and Healthcare Center, Del Norte, CO, United States
The overall purpose of the MDS/Care Plan Coordinator is to manage the integrity of the Facility Medicare/Medicaid Programs. This includes, but is not limited to: verification of eligibility, entitlement and coverage; completion of MDS/PPS and OBRA assessments; accurate and timely submission of all supporting documentation, as well as submission of reports timely to corporate for billing.
ESSENTIAL JOB FUNCTIONS include the following. Other duties may be assigned. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Conducts pre-admission nursing screenings as assigned; ensures Medicare Part A eligibility, entitlement and coverage criteria on all new facility admissions
Obtains Medicare qualifying diagnosis for residents obtaining Medicare A services and updates diagnosis for each change in diagnosis
Prepares, coordinates and maintains schedule of MDS and resident care plans for timely completion. Initiates interim care plan on all admissions/readmissions. Monitors residents for change in condition through facility meetings and ongoing interaction with staff regarding resident’s status. Ensures that resident care plans are updated as needed or indicated
Coordinates weekly Medicare meetings for interdisciplinary team and family care plan conferences
Assures preparation of Medicare denial letters for each resident discharged from Medicare coverage within time limits imposed by Medicare guidelines
Coordinates the distribution of care plan conference invitations to residents and families
Ensures electronic submission of MDS materials to the state regulatory agencies as directed
Utilizes the web based electronic computer programs to monitor the Medicare/Medicaid programs within the facility
Conducts in-service education programs regarding the MDS/Care Plan processes as assigned
Tracks daily eligibility of residents for continued Medicare benefits
Meets with therapists to report resident progress for those residents receiving direct therapy services under Part A or B Medicare services
Responsible for oversight and evaluation of consistency of documentation, care plans, physician orders, etc. to ensure accurate reimbursement
Ensures appropriate, accurate and timely completion of the physician certification/recertification form, SNF determination, and admission letter, SNF determination of continued stay, consent form (non-certified bed letter), beneficiary voluntary placement letter and Medicare secondary payer letter
Maintains back up documentation folders for Medicaid program
Monitors the facility Quality Measures Report and submits this report to appropriate personnel as directed Activity Aide
Monitors the appropriate MDS website for up to date changes in the instructional manual monthly and distributes changes in the instructional manual monthly and distributes changes to the interdisciplinary team as needed
Understands and reviews the facility’s Healthcare Clinical Policies and Procedures and Safety Guidelines
Reports any issues or problems that may arise to the Director of Nursing and/or Administrator
Complies with state, federal, and all other applicable health care and safety standards
Assists families and other visitors as needed
Attends/completes required in-services and other required meetings
Performs other duties as directed
KNOWLEDGE, SKILLS and ABILITIES which may be representative but not all inclusive of those commonly associated with this position.
Language Ability
Reads and interprets documents. Ability to write moderately complex reports and correspondence. Written Communication
Writes clearly and informatively; able to read and interpret written information. Verbal Communication
Talks to others to convey information effectively. English Language
Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar
Math Ability
Knowledge of arithmetic and algebra, and their applications
Reasoning Ability
Ability to apply common sense understanding to carry out detailed written or oral instructions
Customer and Personal Service
Knowledge of principles for providing customer and personal services. This includes meeting quality standards for services and evaluation of customer satisfaction
Medicine
Knowledge of the information and techniques needed to assess and treat human injuries, diseases, and deformities. This includes symptoms, treatment alternatives, drug properties and interactions, and preventive health-care measures
Active Listening
Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times
Problem Sensitivity
The ability to tell when something is wrong or is likely to go wrong. It does not involve solving the problem, only recognizing there is a problem
Quality Management
Demonstrates accuracy and thoroughness
Organizational Support
Follows policies and procedures; completes tasks correctly and on time
Adaptability
Adapts to changes in the work environment; changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events
Planning/Organizing
Prioritizes and plans work activities; advises for additional resources
Attendance/Punctuality
Ensures work responsibilities are covered when absent; arrives at meetings and appointments on time
Dependability
Completes tasks on time or notifies appropriate person with an alternate plan
Professionalism
Treats others with respect and consideration regardless of their status or position; accepts responsibility for own actions
Safety:
Demonstrates ability to locate emergency equipment (i.e. fire extinguisher)
Understands and can demonstrate knowledge of role in fire and disaster drills
Demonstrates ability to identify and respond appropriately to potential behavioral outbursts
Uses facility equipment safely Activity Aide
Recognizes, removes, and/or reports potential hazards
Follows established safety rules/accident prevention
Infection Control:
Demonstrates proper hand washing techniques
Maintains proper food handling techniques and ensures glove usage, when necessary
Disposes of waste properly
Understands and maintains activity/kitchen sanitation procedures, when necessary
Resident Care/Dignity:
Addresses residents in a respectful manner and knocks before entering residents’ rooms
Discusses confidential resident information in appropriate areas only
Education & Experience: an equivalent combination of education, training and experience will be considered.
Graduate from an accredited nursing program; minimum of 2 years of previous long-term care experience; or an equivalent combination of education and experience
Must be licensed in the applicable state as a Licensed Practical Nurse (LPN) or Registered Nurse (RN); Registered Nurse (RN) preferred
Knowledge of RAI, Medicare and PPS processes required
COMPUTER SKILLS/EQUIPMENT USED TO PERFORM THE JOB which may be representative but not all inclusive of those commonly associated with this position.
Desktop/Notebook computers
MS Office (Word, Excel, PowerPoint, etc.)
Various medical equipment
Work Environment & 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. To perform this mission successfully, an individual should possess the physical ability to lift/move 50lbs, maintain a stationary position, move freely, operate equipment, ascend/descend freely, position self to reach equipment above or below normal standing height, and communicate with team members, residents, and residents’ family members.
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ESSENTIAL JOB FUNCTIONS include the following. Other duties may be assigned. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Conducts pre-admission nursing screenings as assigned; ensures Medicare Part A eligibility, entitlement and coverage criteria on all new facility admissions
Obtains Medicare qualifying diagnosis for residents obtaining Medicare A services and updates diagnosis for each change in diagnosis
Prepares, coordinates and maintains schedule of MDS and resident care plans for timely completion. Initiates interim care plan on all admissions/readmissions. Monitors residents for change in condition through facility meetings and ongoing interaction with staff regarding resident’s status. Ensures that resident care plans are updated as needed or indicated
Coordinates weekly Medicare meetings for interdisciplinary team and family care plan conferences
Assures preparation of Medicare denial letters for each resident discharged from Medicare coverage within time limits imposed by Medicare guidelines
Coordinates the distribution of care plan conference invitations to residents and families
Ensures electronic submission of MDS materials to the state regulatory agencies as directed
Utilizes the web based electronic computer programs to monitor the Medicare/Medicaid programs within the facility
Conducts in-service education programs regarding the MDS/Care Plan processes as assigned
Tracks daily eligibility of residents for continued Medicare benefits
Meets with therapists to report resident progress for those residents receiving direct therapy services under Part A or B Medicare services
Responsible for oversight and evaluation of consistency of documentation, care plans, physician orders, etc. to ensure accurate reimbursement
Ensures appropriate, accurate and timely completion of the physician certification/recertification form, SNF determination, and admission letter, SNF determination of continued stay, consent form (non-certified bed letter), beneficiary voluntary placement letter and Medicare secondary payer letter
Maintains back up documentation folders for Medicaid program
Monitors the facility Quality Measures Report and submits this report to appropriate personnel as directed Activity Aide
Monitors the appropriate MDS website for up to date changes in the instructional manual monthly and distributes changes in the instructional manual monthly and distributes changes to the interdisciplinary team as needed
Understands and reviews the facility’s Healthcare Clinical Policies and Procedures and Safety Guidelines
Reports any issues or problems that may arise to the Director of Nursing and/or Administrator
Complies with state, federal, and all other applicable health care and safety standards
Assists families and other visitors as needed
Attends/completes required in-services and other required meetings
Performs other duties as directed
KNOWLEDGE, SKILLS and ABILITIES which may be representative but not all inclusive of those commonly associated with this position.
Language Ability
Reads and interprets documents. Ability to write moderately complex reports and correspondence. Written Communication
Writes clearly and informatively; able to read and interpret written information. Verbal Communication
Talks to others to convey information effectively. English Language
Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar
Math Ability
Knowledge of arithmetic and algebra, and their applications
Reasoning Ability
Ability to apply common sense understanding to carry out detailed written or oral instructions
Customer and Personal Service
Knowledge of principles for providing customer and personal services. This includes meeting quality standards for services and evaluation of customer satisfaction
Medicine
Knowledge of the information and techniques needed to assess and treat human injuries, diseases, and deformities. This includes symptoms, treatment alternatives, drug properties and interactions, and preventive health-care measures
Active Listening
Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times
Problem Sensitivity
The ability to tell when something is wrong or is likely to go wrong. It does not involve solving the problem, only recognizing there is a problem
Quality Management
Demonstrates accuracy and thoroughness
Organizational Support
Follows policies and procedures; completes tasks correctly and on time
Adaptability
Adapts to changes in the work environment; changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events
Planning/Organizing
Prioritizes and plans work activities; advises for additional resources
Attendance/Punctuality
Ensures work responsibilities are covered when absent; arrives at meetings and appointments on time
Dependability
Completes tasks on time or notifies appropriate person with an alternate plan
Professionalism
Treats others with respect and consideration regardless of their status or position; accepts responsibility for own actions
Safety:
Demonstrates ability to locate emergency equipment (i.e. fire extinguisher)
Understands and can demonstrate knowledge of role in fire and disaster drills
Demonstrates ability to identify and respond appropriately to potential behavioral outbursts
Uses facility equipment safely Activity Aide
Recognizes, removes, and/or reports potential hazards
Follows established safety rules/accident prevention
Infection Control:
Demonstrates proper hand washing techniques
Maintains proper food handling techniques and ensures glove usage, when necessary
Disposes of waste properly
Understands and maintains activity/kitchen sanitation procedures, when necessary
Resident Care/Dignity:
Addresses residents in a respectful manner and knocks before entering residents’ rooms
Discusses confidential resident information in appropriate areas only
Education & Experience: an equivalent combination of education, training and experience will be considered.
Graduate from an accredited nursing program; minimum of 2 years of previous long-term care experience; or an equivalent combination of education and experience
Must be licensed in the applicable state as a Licensed Practical Nurse (LPN) or Registered Nurse (RN); Registered Nurse (RN) preferred
Knowledge of RAI, Medicare and PPS processes required
COMPUTER SKILLS/EQUIPMENT USED TO PERFORM THE JOB which may be representative but not all inclusive of those commonly associated with this position.
Desktop/Notebook computers
MS Office (Word, Excel, PowerPoint, etc.)
Various medical equipment
Work Environment & 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. To perform this mission successfully, an individual should possess the physical ability to lift/move 50lbs, maintain a stationary position, move freely, operate equipment, ascend/descend freely, position self to reach equipment above or below normal standing height, and communicate with team members, residents, and residents’ family members.
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