RN Medicare Nurse Case Manager
The Nurse Case Manager (NCM) is responsible for the coordination between the Assessment Department and Interdisciplinary Team (IDT) including scheduling of the RAI process, pre-admissions, admissions, nursing documentation and evaluations for continued stay. The NCM shall ensure an effective assessment program by complying with ethical standards when setting ARDs, completing assessments, and upholding Medicare/Medicaid requirements. The NCM is responsible for adequately assessing nursing facility residents’ needs using the Resident Assessment Instrument (RAI) process and for coordinating individualized resident-centered care. The NCM coordinates with the Interdisciplinary Team to develop, revise, update, and maintain a comprehensive care plan and ensure that compliance is maintained with state and federal guidelines. Coordinates with the Billing Department to assign HIPPS payment categories and UB 04 coding. Develops and monitors on-going MDS schedules for each resident. The NAC assists with the coordination of care delivery by applying advanced nursing clinical skills, completing assessments, analyzing data, educating team members, and coordinating the exchange of resident information across care settings. The NAC works with hospice representatives to coordinate care to the hospice provided resident. Follows a flexible work schedule to cover weekend admissions. Performs general nursing duties as required. If a Registered Nurse, may be designated as RAI Coordinator. The Nurse Case Manager is responsible to the Director of Nursing Services. Responsibilities: Knowledgeable of federal, state, and local government regulations and legislation. Coordinate the RAI process, which includes, at a minimum: Minimum Data Set (MDS) Care Area Assessment process Care plan development Care plan implementation Evaluation Provides oversight of assessment completion and transmission to the national repository. Review final validation reports and corrections or modifications in response to warnings or errors as needed Oversees the baseline care plan and coordinate the completion of the comprehensive care plan according to regulatory requirements. Maintain the MDS OBRA and PPS assessment schedules notifying the IDT of any changes Determines skilled level of care for Medicare residents and procuring required Medicare-specific documentation; responsible for physician certification of a skilled level of care throughout the Medicare stay; involved in making eligibility determinations during the pre-admission and post-admission process. Coordinates care with case managers for residents utilizing managed care, health maintenance organizations (HMOs), commercial insurance, and other alternate payment models Maintains compliance with state-specific regulations regarding the RAI process Provide insight and analysis of MDS-based Quality Measures Serves as a member of the quality assessment and assurance (QAA) and the quality assurance and performance improvement (QAPI) committees Works closely with hospital discharge planners and physicians to obtain accurate and complete documentation to support ICD-10-CM diagnosis coding and surgical procedures Audit and improve staff education/competency as needed to ensure accurate and timely completion of supporting documentation and MDS assessments Participates in discharge planning, training, caregiver training, and the provision of resources as needed Fosters effective working relationships and build consensus16. Maintains confidentiality of sensitive information Plan, organizer, prioritize, work independently, and meet deadlines Use judgment and make sound independent decisions Work effectively with individuals at all levels of the organization, as well as with residents, family members, visitors, government personnel, and the public Identifies cost variances and recommends cost controls related to resource utilization Be knowledgeable of regulations, practice standards, and procedures, as well as laws, regulations, and guidelines pertaining to the RAI process. Possess the ability to plan, organize, develop, implement, and interpret the programs, goals, objectives, policies and procedures, etc., that are necessary for ensuring the accurate and timely completion of the RAI documents Have the ability to learn computer systems, system applications, and related office equipment Ensure that the residents’ rights to fair and equitable treatment, self-determination, individuality, privacy, property, and civil rights, including the right to wage complaints, are always well-established and maintained Attends and communicates information to and from Daily Stand-Up Meeting, Admission Meetings, and Utilization Meetings. Adjusts assignments of assessment department members when necessary (unbalanced workload). Adjusts assignments for absences, vacations, and vacant positions in assessment department. Completes Request for issuance for denial letters. Demonstrates ability to directly perform treatments and provide services to the level of licensure. Knowledge of medication and their correct administration based on age of the resident and their clinical condition. Make rounds on all admissions and re-admissions from the hospital for 30 days from admission and observe for any new or escalating problems. Serves as hospice care coordinator. Job Type: Full-time Pay: From $30.00 per hour Benefits: 401(k) Dental insurance Free parking Health insurance Life insurance Paid time off Vision insurance Experience: LTC: 1 year (Preferred) Geriatric Care: 1 year (Preferred) Care plans: 1 year (Preferred) Nursing: 1 year (Preferred) License/Certification: RN (Registered Nurse) License (Preferred) CPR Certification (Preferred) Work Location: In person