Regional MDS/Case Mix Coordinator - Missouri & Illinois

September 23, 2013 - October 30, 2013
Location:All, MO
Exempt/Non-Exempt:Exempt
Benefits:Health, Dental, Vision, 401(k), Vacation, Personal and Sick Time
Employment Type:Full Time
Department:Clinical Services
Description:Tara Cares, a long-term care administrative support company, is currently seeking a Regional MDS/ Case Mix Coordinator to support facilities in Missouri & Illinois.


Position Summary:

Under the direction of the Senior Vice President of Clinical Services, the Case Mix Coordinator consults with supported facilities to ensure that correct and compliant utilization of Medicare and Medicaid services are maintained. Coordinates tracking of Medicare and Medicaid data, educates facility staff on Medicare and Medicaid from a clinical perspective and routinely audits to ensure facilities are following Federal and State rules and regulations and established company policies and procedures.
Duties:A. Job Knowledge and Role Responsibilities:

1. Demonstrates knowledge of age specific developmental factors specific to adult and geriatric residents (i.e., physical, cognitive, and socialization factors) in directing the overall operation of the facilityís delivery of care.

2. Demonstrates knowledge, skills, and techniques necessary to care for residents with the following needs: therapeutic, neurological and dementia, dialysis, IV therapy, infectious disease, and wound care, if applicable.

3. Acts appropriately under the direction of the Director of Clinical Services and as an active member of the interdisciplinary and regional team.

4. Demonstrates ability to adjust to changes in assignments to meet resident and family needs.

5. Implements established Medicare and Medicaid policies and procedures.

6. Educates new and current staff on established Medicare and Medicaid policies and procedures.

7. Performs routine audits of the facility for compliance with established Medicare and Medicaid policies and procedures and rules and regulations.

8. Assists the facilities to implement restorative nursing programs.

9. Educates the facility staff as appropriate on Medicare and Medicaid maximization following the guidelines of Medicare and Medicaid.

10. Communicates and observes the Compliance Program effectively and complies with Code of Conduct when performing work functions.

11. Demonstrates knowledge of the 34 and 53 RUG grouper categories and documentation guidelines.

12. Demonstrates knowledge of analyzing and tracking the Case-Mix Roster report and making recommendations accordingly.


B. Administrative Responsibilities:

1. Develops and periodically updates Medicare and Medicaid policies and procedures as changes occur.

2. Develops systems to assist in maintaining compliance.

3. Assist facility with Development of Action Plans for the facility to correct issues identified through audits.

4. Communicates with the interdisciplinary and regional team to assist in problem solving.

5. Periodically attends facility Medicare meetings.

6. Attends meetings as requested by the facility and the Director of Clinical Services & Case Mix as needed.

7. Notifies Director of Clinical Services immediately of issues of compliance/facility problems.


C. Role Responsibilities

1. Audits the medical record for documentation of skilled services.

2. Monitors the PPS Tracking Logs.

3. Audits to ensure the Medicare non-coverage letters are complete and sent timely.

4. Audits and ensures the Physician Certification re-certification are complete and accurate.

5. Audits a sample of the UB-92ís and compares to the medical record to ensure the medical record supports the claim.

6. Monitors ADL documentation for compliance.

7. Assists the facility with ADRís and Denials.

8. Monitors the Nursing Restorative Log.

9. Monitors the 30-Day Tracker.

10. Analyzes statistical data.

11. Assists the facilities in Medicare and Medicaid maximization.

12. Communicates with therapy and billing staff as needed.

13. Interacts with the Fiscal Intermediary in areas of coverage and documentation.
Qualifications:1. Maintains a current, valid license as an LPN, or RN, BSN preferred, and is in good standing.

2. Possesses a minimum one (1) year of experience in Nursing Service Administration. Additional education or experience in such areas of rehabilitative or geriatric nursing is preferred.

3. Possesses strong knowledge of state, federal, and local regulations as they pertain to long-term care.

4. Maintains rapport with outside medical professionals. Must meet health assessment requirements, including two stage Mantoux skin test.

5. Must be capable of performing the essential functions of the job, with or without reasonable accommodations.

6. Must be able to communicate in English, both verbally and in writing, and possess sufficient communication skills to perform the tasks required.


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