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:

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

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

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

1. 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.

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

1. 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.

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

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

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

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

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

1. 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:

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

1. 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.

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

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

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

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

1. 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 abili