MDS -Clinical Reimbursement Coordinator - Winner Regional Health : Job Details

Position Summary:The Registered Nurse or LPN in long term care must adhere to the RN legal scope of practice. The RN role is responsible for utilizing the nursing process to provide quality, competent nursing care in the LTC setting to residents families and significant others. So clinical skills expected are: age related resident protocols, medication administration, skin wound care, and ongoing assessments. This role must work collaboratively with other team members, physicians, and healthcare workers to deliver quality care. Following a competency based formal evaluation completion and performance is expected. Must become competent in MDS assessment and Medicare task documentation. Must understand and use nursing process, must be able to critically think and be self-directed to manage resident care. Must be able to effectively delegate, collaborate, and negotiate with team members. Must be flexible in scheduling and resident care activities/needs. Must handle stressful situations effectively. Must be able to resident teach, be able to communicate effectively with residents, family, physicians, and other providers. When students are providing resident care, treatment, and/or services as part of their training any or all employees may be asked to supervise employees.The Clinical Reimbursement Coordinator is responsible for overseeing the accurate completion of the Minimum Data Set (MDS) process with all of its components. In addition he/she is responsible for Medicare management, restorative nursing, admissions and documentation of the residents assigned to him/her. The nurse in this role will work collaboratively with the interdisciplinary team, the Administrator, Director of Nursing, Physicians, Direct Care Staff, as well as the Residents and their families. This nurse is responsible for utilizing the nursing process to assure that the residents have a care plan that promotes quality, competent nursing care, meeting state and federal guidelines. The nurse in this role must understand and use the nursing process, must be able to have good critical thinking skills and be self-directed. This nurse will be knowledgeable and trained in the MDS, Medicare, and restorative nursing. This position will be included in the LTC Administrator on Call rotation.The responsibilities of the Clinical Reimbursement Coordinator include scheduling of all OBRA and PPS Resident Assessment Instruments (RAI) to be in compliance with regulatory date requirements; overall coordination of all required Resident Assessment Instruments (both OBRA and PPS) per state and federal regulations to ensure timely completion; timely transmissions of all required MDSs per state and federal regulations; manages follow-up of all transmission error issues in timely manner and in compliance with HCFA regulations; monitoring of RAI process for timely completion of all elements, i.e. MDS, CAA's, Care Planning, Transmissions, and error follow up; coordinating PPS/MDS process for maximization of Medicare reimbursement and compliance with related regulations; monitoring of input into the MDS to ensure accuracy of the RAI process and acting as resource to all team members when questions arise on how to answer questions on the MDS; mentoring and teaching of RAI team members in RAI process and PPS process to increase competency in their designated roles; maintaining timely communication with the Accounts Receivable department regarding completion of RAI process as it relates to billing; monitoring of compliance with state and federal regulations as they relate to the RAI/PPS process including concurrent tracking systems, sample audits for MDS accuracy, etc.; supervision of RN Assessment Coordinators, RAI/PPS Assistant and Medicare Case Manager(s); supervision of the HIM Program/Department; collaboration with AR and Clinical Departments on the RAI/PPS process and compliance with related state and federal regulations; facilitates Medicare meetings; maintaining current knowledge regarding state and federal regulations relative to the RAI process and PPS process, including state case mix.; communicates daily with Rehab staff regarding needed therapy resources, continued coverage, discharge plants, etc.; consults routinely with the primary nurse assigned to each resident regarding the resident's Medicare/HMO status; consults routinely with the primary social service worker regarding the resident's discharge plan; maintains Medicare/PPS and HMO tracking systems to monitor compliance with all clinical PPS process regulations and HMO contract requirements; active interaction with IDT on daily basis and during rounds to evaluate each resident's status and needs relative to Medicare/HMO skilled needs and potential for changes in needs/resources and continued coverage; review of each Medicare and HMO resident's case on day of admission or closest workday following weekend admission to ensure appropriateness of Medicare coverage/HMO coverage. On call duties as assigned. Other duties as assigned.The Clinical Reimbursement Coordinator must be able to handle stressful situations effectively. He/She must be able to teach and communicate effectively and professionally with the residents, family members, practitioners and other team members.RequirementsEducation/Experience:RN or LPN - Graduate from an American College of Nursing or National League for Nursing accredited college of nursing. Current South Dakota RN license is required, or multi state licensure privileges. One year experience as RN Assessment Coordinator in a Long Term Care facility. Intimate knowledge of RAI/PP process regulations; Two plus years as Long Term Care Nurse.Required Credentials (Licensure, Certification, or Registration):Current RN or LPN license to practice in the State of South Dakota or multi-state licensure privileges.Employment Variables:Scheduled work hours set forth by supervisor and team manager. Works every schedule; this position is included in the LTC Administrator on Call rotation. Occasionally may need to work beyond normal work hours. This is a full time position. Initial Tuberculosis (TB) test and drug screening is required by Winner Regional Health. Rubella titer will also be drawn upon hire and immunization is required if no past exposure or indication of immunization. Required to wear name tag provided by WRH and to follow the dress code of WRH. Job Knowledge and Skills:Ability to read, write, speak, and understand the English language. Excellent oral and written communication skills. Ability to deal with people in a professional manner. Knowledge of nursing and medical practices, procedures, laws, regulations, and guidelines that pertain to Long Term Care. Direct Supervisor:Director of NursingPART II: CODE OF CONDUCT Honesty We will do the right thing at all times, even if it is difficult, maintaining strong, ethical practices. We protect the confidentiality of others, including patients, staff and the facility as a whole. We will take responsibility for our actions. Expertise We will demonstrate superior judgment, training and skill, at all times, demonstrating professionalism while doing so. We will perform all aspects of our job to the best of our ability, utilizing all resources and tools available. Approachability We will be non-judgmental, friendly, and open and willing to listen to everyone we come into contact with while performing our duties. We are humble and learn from others. Respect We will be understanding and sensitive to others' feelings; caring and responding in a manner that sets them at ease, keeping the situation in perspective without minimizing others' feelings or reactions. We will listen to others with full attention in a sincere, civil fashion, being careful not to be judgmental of the speaker. We maintain composure when facing conflict and avoid jumping to conclusions and defaming another's name. Teamwork We willingly work together with a common approach, trusting and supporting members of our organization, using our skills and resources, sharing information to achieve a common aim.PART III: ESSENTIAL FUNCTIONSEssential functions are critical or fundamental to the performance of the job. They are the major functions for which the person in the job is held accountable. Following are the essential functions of the job, along with the corresponding performance standards.Function ExplanationAssessmentCollects and organizes pertinent resident assessment data. Seeks information from resident, family, health care providers and environment on an ongoing basis. Uses established assessment forms to document assessment of resident's emotional, spiritual and physical care needs. Completes admission assessment within time frame identified in admission policy. Serves as the RN MDS coordinator to the interdisciplinary team in accurate completion of the MDS process. Responsible for oversight and review of Medicare, and the restorative nursing care process.Clinical DutiesActively participates in committees to complete the work of the department. Demonstrates effective coping skills. Demonstrates planning and implementation skills complying with department norms. Serves as a role model and shows congruence between words and actions as well as follows through on agreements. Develops and maintains competency related to technology and equipment. Develops process for record keeping of competencies. Identification of OutcomesDevelops plan of care consistent with assessment data with the interdisciplinary team. Involves resident, family and healthcare providers to identify outcomes. Incorporates cultural needs/diversity in individualized resident outcome identification. Defines outcomes with attainable timeframes. Documents outcomes as measurable goals. Documents outcomes as measurable goals within the framework of nursing care and Medicare stay.PlanningDevelops a plan to provide direct nursing care to attain outcomes. Individualizes plan based upon identified resident needs, such as economic impact, cultural concerns. Prioritizes implementation of diagnoses and interventions based on resident condition. Utilizes standardized terminology to communicate to others. Works closely with the Charge Nurse in the development of a plan to provide direct nursing care to attain outcomes.ImplementationImplements the interventions identified in the plan of care. Carries out interventions in a safe and timely manner. Incorporates evidenced-based treatments in care of resident. Uses resources and collaborates with others to implement plan. Documents intervention implementation, noting exceptions/modificationsEvaluationEvaluates the resident's progress toward attainment of outcomes. Utilizes an organized ongoing process to determine outcome attainment based on the plan of care. Includes resident, family, health care providers involved in resident care in evaluation process. Documents evaluation findings. Utilizes evaluation data to revise as necessary, diagnoses, outcome, plan and implementation process. Communicates results to resident and those involved in care . Communicates with direct care and Charge Nurse and shares results at the Medicare meeting.Quality of CareSystemically evaluates the quality and effectiveness of nursing practice. Documents in a responsible, accountable and ethical manner. Uses results of quality improvement activities to initiate change. Implements creativity and innovation to improve care delivery. Participates in quality improvement activitiesPerformance AppraisalEvaluates his/her own nursing practice in relation to professional practice standards and relevant statues and regulation. Engages in self evaluation on regular basis, identifies strengths and weaknesses. Obtains informal feedback on performance from residents, peers, colleagues, others. Acts to achieve identified performance goals. Provides rationale for practice behaviorsEducationAcquires and maintains current knowledge in nursing practice. Participates in ongoing educational related activities. Demonstrates commitment to lifelong learning. Seeks experiences to maintain skills and competence for role performance. Maintains records to support competency and lifelong learning. Participates in ongoing education related to Medicare and provision of care.Educational ProgramsProvides ongoing needs assessments to determine employee and organizational needs. Collaborates with staff, managers, and other educators to identify educational needs. Develops educational programs based on assessment findings and healthcare changes and trends so all programs incorporate current information. Implements programs based on PI input, competency issues, and requests and/or needs. Develops/coordinates 2-3 in-services per year. Evaluates programs.CollegialityContributes to the professional development of peers, colleagues and others. Shares knowledge and skills with others (resident conference, meeting presentations, precept/mentoring). Provides peer feedback in constructive manner. Engages in direct one-to-one communication. Interacts with peers and colleagues to enhance performance. Contributes in a positive manner to the environment, making conducive to education and learningDuties and ResponsibilitiesAssists in supervision of Nursing Service as directed by D.O.N. Provides leadership and direction in accordance with the organizational and departmental goals and objectives. Coordinates services rendered by nursing personnel with those of other departments to promote team work throughout the facility. Assist D.O.N. in the development and maintenance of policies and procedures for Nursing Service. Assist D.O.N. in the maintenance of required records/reports in Nursing Service for any approval agency. Familiar with organization and function of all departments and LTC policies, procedures and regulations. Provides timely and proper notification for absences and paid personal leave. Finds a replacement when necessary. No unexcused absences or excessive tardiness. Knows emergency procedures for fire, internal / external disaster plans, codes, etc. and participates in drills. Verbally supportive of Winner Regional Health and the Sanford Health Network. Participates on committees and/or is involved in special projects of Winner Regional Health. Provides for patient, resident, employee, and visitor safety through preventative measures. Identifies hazards and reports incidents. Utilizes and adheres to appropriate precautions/techniques with hazardous chemicals, blood and body fluids, medical waste and/or equipment. Satisfactory attendance at department meetings (50% meets expectation). Is cross-trained to other areas/positions/departments to provide assistance when needed. PART IV: COMPLIANCECompliance Must comply with the Corporate Compliance Policy and all laws, rules, regulations and standards of conduct relating to the position. The employee has a duty to report any suspected violations of the law or the standards of conduct to the Compliance Officer or the Chief Executive Officer.PART V: PHYSICAL AND MENTAL REQUIREMENTSGeneral ActivityIn a regular workday, employee may:

• Sit 1/2
• Hours at a time; up to 1-1.5
• Hours during the day
• Stand 3 Hours at a time; up to 6.5 Hours during the day
• Walk
• Hours at a time; up to 4-6
• Hours during the day

MotionEmployee is required: (In terms of a regular workday, Occasionally equals 1% to 33%, Frequently 34% to 66%, Continuously , greater than 67%.)

• Bend/Stoop Occasionally
• Kneel, Duration 30 sec Occasionally
• Squat Occasionally
• Balance Occasionally
• Crawl, Distance Not at all
• Twist Occasionally
• Climb, Height Occasionally
• Keyboarding/Mousing Occasionally
• Reach above shoulder level Occasionally

Physical DemandEmployee's job requires he/she carry and lift loads from the floor, from 12 inches from the floor, to shoulder height and overhead. Employee's job requires a pushing/pulling force to move a load (not the weight of the load).Physical Demand Classification: Carrying/lifting weight and pushing/pulling force:

• Medium
• Occasionally 50 lbs.
• Frequently 25 lbs.
• Constantly 10 lbs.

Sensory Requirements: Yes/No Explanation (if Yes)

• Speech Expressing or exchanging ideas by means of the spoken word. Those activities in which they must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly. Yes
• Need to continuously communicate with residents and co-workers.
• Vision (VDT) Are there specific vision requirements for the job? Yes
• Need to accurately measure intake and output; work with multiple tubes, drains, monitoring equipment, etc. Must be able to visually assess residents, including color recognition.
• Hearing Ability to receive detailed information through oral communications, and to make fine discriminations in sound; i.e., making fine adjustments on machine parts, using a telephone, taking blood pressures. Yes
• Need to continuously hear instructions from co-workers, physicians, request from residents. Need to hear BP and monitor alarms, assess by auscultation.
• Smell Checking for odors related to infections Yes Checking for odors related to infections

Environmental FactorsYes/No Explanation (if Yes)

• Working on unprotected heights No
• Being around moving machinery Yes
• Pheresis equipment
• Exposure to marked changes in temperature and humidity No
• Driving automotive equipment No
• Wearing personal protective equipment Yes
• Exposure to blood/body substances and other chemicals
• Exposure to atmospheric conditions (i.e. fumes, dust, odors, mists, gases, or poor ventilation) Yes
• Potential chemical exposure
• Exposure to extreme noise or vibration No
• Exposure to blood, body fluids and waste Yes
• As Above.
• Exposure to radiation Yes
• X-rays
• Exposure to other hazards (i.e. mechanical, electrical, burns, or explosives) Yes
• Chemotherapy agents

Emotional/Psychological FactorsYes/No Explanation (if Yes)

• Stress: Exposed to stressful situations Yes
• Dealing with residents, families and others who may be very upset. Has high accountability for tasks performed.
• Concentration: Must be able to concentrate on work tasks amidst distractions. Yes
• Work must be done accurately even when multi-tasking. Mistakes may be harmful to resident outcomes.
• Must exert self-control. Yes
• Due to stressful situations regarding resident needs, must maintain composure at all times. Will give directions and take directions from multiple sources.

PART VI: JOB RELATIONSHIPSSupervises0 No supervisory responsibilities1 Supervisory responsibility# Direct Reports: depends upon shift# Indirect Reports: Age of Resident Populations Served 0 Neonates: 1-30 days

• 0 Infant: 30 days - 1 yr
• 0 Children: 1- 12 yrs
• 0 Adolescents: 13- 18 yrs
• 1 Adults: 19- 70 yrs
• 1 Geriatrics: 70+ yrs
• 1 All
• 0 Not applicable

Internal Contacts1 Residents1 Providers: (i.e. Physicians, Therapists, Social Workers)1 Staff: (i.e. clinical and administrative support staff)1 Volunteers0 Others: External Contacts1 Residents1 Families/Significant Others1 Providers1 Vendors1 Community and Health Agencies1 Regulatory agencies1 Other: Job Applicants