RN - Medicare Nurse Case Manager

*\*\*\*Sign on Bonus\*\*\* Monday-Friday 8a-4:30pm.
Must have current Louisiana RN license.
Pay depends on experience.
* *Please come by to fill out application with Lynn and bring drivers license, social security card and COVID card if you have been vaccinated.
Usually same day interviews.
* The Nurse Case Manager (NCM) is responsible for the coordination between the Assessment Department and Interdisciplinary Team (IDT) including scheduling of the RAI process, preadmissions, 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 NCM 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 NCM 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.
*Responsibilities* 1.
Knowledgeable of federal, state, and local government regulations and legislation.
2.
Coordinate the RAI process, which includes, at a minimum:  Minimum Data Set (MDS)  Care Area Assessment process  Care plan development  Care plan implementation  Evaluation 3.
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 4.
Oversees the baseline care plan and coordinate the completion of the comprehensive care plan according to regulatory requirements.
5.
Maintains the MDS OBRA and PPS assessment schedules notifying the IDT of any changes 6.
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.
7.
Coordinates care with case managers for residents utilizing managed care, health maintenance organizations (HMOs), commercial insurance, and other alternate payment models 8.
Maintains compliance with state-specific regulations regarding the RAI process and case mix requirements.
9.
Provide insight and analysis of MDS-based Quality Measures 10.
Serves as a member of the quality assessment and assurance (QAA) and the quality assurance and performance improvement (QAPI) committees as requested by the DON.
11.
Works closely with hospital discharge planners and physicians to obtain accurate and complete documentation to support ICD-10-CM diagnosis coding and surgical procedures 12.
Audits and improves staff education/competency as needed to ensure accurate and timely completion of supporting documentation and MDS assessments 13.
Participates in discharge planning, training, caregiver training, and the provision of resources as needed 14.
Fosters effective working relationships and builds consensus 15.
Maintains confidentiality of sensitive information 16.
Plans, organizers, prioritizes, work independently, and meets deadlines 18.
Uses judgment and makes sound independent decisions 17.
Works effectively with individuals at all levels of the organization, as well as with residents, family members, visitors, government personnel, and the public 18.
Identifies cost variances and recommends cost controls related to resource utilization 19.
Be knowledgeable of regulations, practice standards, and procedures, as well as laws, regulations, and guidelines pertaining to the RAI process.
20.
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 21.
Have the ability to learn computer systems, system applications, and related office equipment 22.
Ensure that the residents’ rights to fair and equal treatment, self-determination, individuality, privacy, property, and civil rights, including the right to file grievances are always well-established and maintained Job Type: Full-time Pay: From $27.
00 per hour Benefits: * 401(k) * 401(k) matching * Dental insurance * Disability insurance * Health insurance * Life insurance * Paid time off * Vision insurance Healthcare setting: * Long term care * Nursing home Medical specialties: * Geriatrics Schedule: * 5x8 * Monday to Friday Experience: * MDS: 1 year (Required) License/Certification: * RN (Required) Work Location: In person