LPN/ RN Nursing Coordinator / Healthcare Coordinator

Responsible for the coordination of the Resident Assessment Instrument (RAI) process to ensure accurate and timely completion of resident assessments in accordance with Medicare, Medicaid, OBRA and other payer program requirements.

Ensures assessments accurately reflect the physical, mental and psychological status of each resident; Follows all Next Step Healthcare policies and procedures.

Ensures timely, accurate, and complete assessment of the resident's health and functional status during the entire assessment period.

• Ensures accurate and timely completion of all Medicare/Medicaid case-mix documents in order to assure appropriate reimbursement for services provided within the facility.
• Works in collaboration with the facility Director of Rehab to ensure the most appropriate assessment reference date (ARD) is utilized for Medicare/Managed Care Assessments.
• Tracks Skilled (MRA/HMA/HMO) customers utilizing Case Management Tools to determine continued and appropriate Medicare/Managed Care eligibility and benefit period through regular communications with Clinical Reimbursement Specialist, Business Office and external Case Managers.
• Ensures that additional requirements of the Medicare Program are met, such as Physician certification and re-certification.
• Participates in the interdisciplinary team process to communicate opportunities, facilitate efficient and effective care plan development and management.
• Collaborates with the interdisciplinary team to identify significant change in status and implementation of Significant Change in Status MDS.
• Maintains an accurate schedule of all MDS assessments to include the proper reference dates throughout the residents stay.
• Performs Modifications/Inactivation's of assessments in accordance with CMS Correction Policy and collaboration with Clinical Reimbursement Specialist.
• Ensures the timely electronic submission of all Minimum Data Sets and secures back-up personnel to complete this process.
• Communicates with the Business Office and Administrator on a regular basis regarding RUG/PDPM distribution, default days/unassigned days, case mix index (if applicable).
• Reviews discharged managed care with BOM on a weekly basis.
• Participates in month end Triple Check and other meetings per Next Step Healthcare's policy.
• Facilitates Case Management meeting per Next Step Healthcare's policy.
• Functions as an RAI and Clinical Reimbursement resource to the facility staff.
• Utilizes Relias annual competency training as well as for educational resource as needed.
• Assists in the orientation and training of new associates on the RAI process and ensures the dissemination of any new or updated materials regarding the RAI and/or Federal and State regulations.
• Ensures timely RN coordinator signatures.

Maintains current knowledge of reimbursement regulations.

• Maintains data in an organized, easily retrievable manner.
• Maintains good personal hygiene and follows dress code requirements.
• Communicates regularly with the Clinical Reimbursement Specialist to discuss identified clinical reimbursement concerns and/or opportunities.
• Must be a graduate of an accredited school of nursing with current RN or LPN licensure in the state in which employment occurs.
• Minimum of two years health care experience.
• Experience with MDS completion, reimbursement, clinical resource utilization and/or case management is highly desirable.
• Ability to work flexible work hours to support business requirements.
• Complete and pass all Next Step Healthcare specific MDS/RUGs training modules (Relias) within the first 90 days of employment and ongoing per company policy.
• Competency with standard office software applications as well as software applications related to MDS/RAI processes.
• Ability to utilize both local and corporate resources in the execution of job responsibilities.

Customer Service Oriented

• Ability to be patient while interacting with challenged or difficult residents
• Ability to create a resident-centered environment
• Knowledge of policies and procedures and state and federal regulations

Successful demonstration of work standards, quality work product, productivity, and job knowledge are standard expectations

Shoe the amount of time on-the-job in the following physical activities by checking the appropriate boxes below.

Ability to hear alarms on equipment

Ability to hear instructions from physician/department staff