The rac rn (Resident assessment coordinator) reports to the executive director and is responsible for accurate and timely completion of mds assessments and coordination of the rai process. Provides Medicare, Medicaid (Case Mix) and Managed Care oversight to ensure appropriate clinical services are provided and appropriate reimbursement is received for each resident. This includes ensuring that the centers are in compliance with Federal and state regulations as well as the communicare family of companies guidelines and policies and procedures. this role serves as a key member of the facility’s management team in helping the facility obtain/maintain quality outcomes.

Job duties & responsibilities

• MDS scheduling and completion per rai guidelines including coordinating care plan development and completion with the interdisciplinary team
• responsible for development of an individualized, comprehensive resident care plan with the interdisciplinary team ensuring care area triggers are addressed
• ensures care plans are reviewed quarterly and updated as needed to reflect current resident status with individualized problems, goals, and interventions
• coordinates with other disciplines to ensure timeliness of assigned sections of mds completion reporting noncompliance to executive director
• signature of mds sections v0200b comprehensive caa completion and z0500a mds completion
• oversees clinical reimbursement and case management services within the center for Medicare A and B, Managed Care, Insurance, and Medicaid (Case Mix)
• directs and oversees the implementation of the Communicare Family of Companies programs, policies, and procedures related to the rai process to ensure appropriate care is rendered and appropriate reimbursement is obtained
• coordinates the timely and effective service delivery for all residents while ensuring quality clinical outcomes with appropriate reimbursement
• advocates on behalf of the resident and facility for needed resident resources and services
• provides education to other health care providers, the facility’s care team, and the resident/family on Medicare, Medicaid (case Mix), Managed Care, and MDS completion
• works as a liaison between the facility, the resident/family, rehabilitation, and other care providers
• oversees and monitors mds documentation and charting requirements that support services provided to meet billing requirements including state specific requirements for supportive documentation
• provides oversight of the medicare and managed care residents and coordinates rehabilitation, optimal recovery, and assists with discharge planning
• oversees the validation of medicare entitlement and eligibility for prospective residents
• completes chart audits to assess the quality of the documentation to support skilled Medicare, Managed care, and medicaid coverage
• oversees the completion of certifications/recertifications
• ensures Medicare part a and b services are appropriately billed and meet medicare documentation guidelines
• oversees the resource utilization of services covered under consolidated billing as well as ancillary costs
• directs the completion of Requests for additional information claims requests and appeals for denied Medicare, Managed Care, and Medicaid claims
• possesses knowledge of facility managed care contract coverage guidelines, outliers, and contracts to ensure care is provided and billed appropriately
• acts as a liaison with the managed care plan provider to communicate resident needs while representing the interests of the facility and resident
• ensures compliance with federal and state regulations as well as the communicare family of companies policies and procedures regarding state specific case mix
• Participates in facility meetings per policy
• oversees MDS accuracy and pertinent narrative data to support mds assessment
• performs other duties as assigned
• conducts job responsibilities in accordance with the standards set in the code of conduct, policies and procedures, applicable federal and state laws, and applicable professional standards

Qualifications

• graduate of an accredited school of nursing; rn
• valid rn license in the state employed
• three years of experience in a long term care environment preferred
• experience with the mds/rai process and/or case management preferred

Knowledge/Skills/Abilities

• ABILITY TO WORK COOPERATIVELY AS A MEMBER OF A TEAM
• BASIC COMPUTER SKILLS SUCH AS EMAIL, SIMPLE SPREADSHEETS, AND DATA ENTRY
• DEMONSTRATES CLINICAL ASSESSMENT SKILLS TO MEET THE JOB REQUIREMENTS
• ABILITY TO COMMUNICATE EFFECTIVELY WITH RESIDENTS AND THEIR FAMILY MEMBERS, AND AT ALL LEVELS OF THE ORGANIZATION
• KNOWLEDGE OF FEDERAL AND STATE REGULATIONS PREFERRED
• KNOWLEDGE OF THE RAI PROCESS PREFERRED
• ABILITY TO BE ACCURATE, CONCISE, AND DETAIL ORIENTED
• ABILITY TO MAINTAIN CONFIDENTIALITY

Work environment

• May work beyond normal working hours, on weekends and holidays, when necessary.
• Is subject to frequent interruptions.
• Field based work required. Occasional overnight travel will be required as times with field based assignments.

Physical effort/demands (With or Without the Aid of Mechanical Devices)

• Ability to move (sit, stand, bend, lift) intermittently throughout the workday.
• Ability to lift, push, pull, and move a minimum of 50 pounds.

Mental effort/demands (With or Without the Aid of Mechanical Devices)

• Ability to function independently and have flexibility, personal integrity, and ability to work effectively with staff and support agencies.
• In good health and demonstrating emotional stability.
• Ability to cope with the mental and emotional stresses of the position.

Communication (With or Without the Aid of Mechanical Devices)

• Must be able to read, write and speak the English language in an understandable manner.

Sensory requirements (With or Without the Aid of Mechanical Devices)

• Ability to see and hear or use prosthetics that will enable these senses to function adequately to assure that the requirements of this position can be fully met.