MDS Nurse (2 years experience Preferred)
Company: Hudson Elms Nursing Home
Location: Hudson
Posted on: September 24, 2024
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Job Description:
Position is Part-Time twenty (20) hours per week.POSITION
SUMMARY:Coordinates and monitors Medicare, Managed Care and
Medicaid revenue at the facility.Ensures residents receive optimal
skilled services to meet needs for optimal independent function and
potential discharge to the community including management of the
MDS process and serving as liaison for insurance companies.
Monitors facility Quality Measures, identifies issues related to
Quality Measures and assists facility with aOhio corrective actions
needed to improve overall quality services. Educates Administrator
and facility staff on innovative procedures to optimize utilization
and reimbursement through the completion of the MDS, care plan and
care guide process.ESSENTIAL POSITION FUNCTIONS:1. Participates in
the Nursing Management weekend on-call rotation and assists in help
with medication administration in emergencies. 2 . Education -
Provides education and assistance to facilities on
Medicare/Medicaid related areas including eligibility,
certification, coverage, documentation, utilization and
reimbursement.Assists facilities with initial certification
procedures and follow-up of problem areas.Updates policies and
procedures to reflect current changes. 3. Coordination - Interacts
with Medicare, Managed Care and Medicaid claims review unit and
compliance unit to assist facilities in complying with compaOhio
procedures and federal, state and local regulations.Reports
regularly to administration on issues and activities.Interacts with
the Medicare and managed Care intermediary in professional areas of
coverage and documentation.Assists in review and preparation of
denied claims or administrative record reviews by outside
intermediaries. Responsible to coordinate weekly Insurance/Medicare
Meeting for the purpose of evaluating resident progress and ongoing
skilled service's needs. 4. Monitoring -Completes and assess
compliance with Medicare, Managed Care andMedicaid and third party
payers and compaOhio procedures.Establishes systems and programs
designed to correct aOhio non-compliance situation. Participates
with aOhio outside reimbursement audits to acquire first hand
knowledge of areas that might lead to system failures. 5.
Administration - Establishes and maintains current statistical data
associated with the Medicare, Managed Care and Medicaid programs by
region.Cooperates with operations to monitor activities for
contractor programs, i.e. therapies, utilization review.Reviews and
maintains Medicare, Managed Care and Medicaid reference materials.
6. Financial Management - Monitors and identifies utilization
issues.Establishes systems and programs to maximize utilization and
reimbursement.Establishes system to identify rehabilitations
training needs to provide training and recommendations to enhance
therapy utilization.Monitors compliance with third party policies
and procedures for authorizations for payment and provision of
services. 7. Training - Provides ongoing orientation and training
to appropriate facility staff regarding the Medicare, Managed Care
and Medicaid and other contracted third party payers.
Programs.Provides education regarding changes in aOhio program. 8.
Meetings - Coordinates, facilitates and attends meetings. 9.
Committees - Attends and participates in committees as assigned.
10. Staff Development - Attends and participates in training and
other learning activities at the facility level. 11. Gathers data
and gives direction to acquire accurate and timely completion of
MDS 3.0 as it relates to Medicare, Managed Care and Medicaid.
Monitors, coordinates and enhances the completion of the MDS and
the interdisciplinary team members in a professional manner. 12.
Makes ones self available for Regional visits to acquire knowledge
and discuss Ohio on-going issues at the facility level as it
relates to the accurate and timely completion of the MDS. 13. Is
the chair person for the care plan meeting and conducts those
meetings in a thorough manner capturing the accurate information
revealed through the completion of the MDS. 14. Audits adl logs and
assessments etc. to ensure that information is accurate and timely
in completing the MDS assessment tool. 15. Communicates and
observes the Corporate Compliance Program effectively and complies
with Code of Conduct when performing work functions. SUMMARY OF
QUALIFICATIONS: Able to perform each of the essential position
functions. 1. Prefer two year's experience in Medicare/Medicaid
areas in long-term care or clinical training. 2. Must have
excellent communication and teaching skills in both individual and
group settings. 3. Must be capable of maintaining regular
attendance and be available to travel including overnight travel as
required. 4. Must be capable of performing all of the essential job
functions of this position, with or without reasonable
accommodations. 5. Possess working knowledge of MDS 3.0, care
plans, care guides and the CMI reimbursement process.
Keywords: Hudson Elms Nursing Home, Cuyahoga Falls , MDS Nurse (2 years experience Preferred), Healthcare , Hudson, Ohio
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