HealthSource Saginaw (HSS) is looking for an MDS Nurse who is passionate about the work they do and who enjoy working in a fast paced, patient centered environment. You will be challenged by the dynamic environment, where you will work as a pivotal member of the staff, to exceed company goals and foster teamwork. If you want to play an integral role in providing care and support to patients, then consider working for us. As an HSS employee, you will become part of our team of outstanding people working together to improve the physical and emotional health of the lives we touch each and every day.
HSS provides shift and Holiday premiums, tuition assistance and a comprehensive benefit package including paid time off, major medical, prescription, vision, dental, defined contribution plan with up to 7% employer match, health reimbursement account, flex-spending account and short and long term disability to eligible positions. HSS is a qualifying employer for the Public Service Loan Forgiveness (PSLF) program.
Pre-employment physical, drug screen and background check required. HealthSource Saginaw is an EEO/Affirmative Action employer for all including Women, Minorities, Veterans and Individuals with disabilities.
Requirements
- Registered Nurse (RN), Licensed Practical Nurse (LPN) or Bachelor’s Degree in related field preferred.
- Must possess high level of clinical and technical expertise in areas of Utilization Management, MDS, RAI and 3rd party reimbursement, a working knowledge of diagnoses.
- Resident Assessment Coordinator (RAC) certification is required and must be obtained within 12 months of hire.
- Work requires a substantial level of knowledge of Hospital policy and procedures, MDS, RAI and Utilization management concepts generally attainable through 18 - 24 months experience.
Summary
Evaluates patients/residents and/or their medical information before, during and after admission to justify the Level of Care and the need for continued hospitalization.- Coordinates the facility’s Resident Assessment Instrument (RAI) process in accordance with state and federal regulations.
- Utilizes the current RAI manual as a resource during the assessment coding process.
- Schedules the Assessment Reference Dates (ARD’s) for payment assessments in a manner that accurately captures each resident’s clinical characteristics for payment classification purpose.
- Schedules the ARD’s for all OBRA assessments daily, monthly and as needed.
- Provides a schedule of ARD’s and assessment type weekly and as needed to the interdisciplinary team (IDT) in order to facilitate the timely completion of MDS sections and CAA’s (Care Area Assessments) by each discipline.
- Communicates with members of the IDT as needed for timely completion of assessments. Expected to report any issues with timeliness to the MDS Coordinator.
- Transmits assessments in accordance with current regulations to facilitate timely receipt of validation reports, transmits as frequently as necessary to obtain timely validation of MDS acceptance into the Quality Improvement and Evaluation System (QIES) Assessment Submission and Processing System database.
- Confirms transmission files by review and printing of initial and final validation reports.
- Corrects fatal errors immediately and retransmits the assessment until an accepted validation report is received.
- Addresses nonfatal errors using the QIES ASAP system MDS 3.0 provider User’s Guide.
- Ensure the Business Office designee receives the initial and final validation report that acknowledges the acceptance of the MDS into the QIEs system.
- Accurate completion of all MDS assessments and any supporting assessments of clinical documentation.
- Implementation and ongoing evaluation of each patient’s/resident’s comprehensive plan of care. Scheduling and leading interdisciplinary care plan team meetings.
- Auditing medical records for the presence of supporting documentation for all items coded on the MDS. Provide education to department heads, physicians, and other staff as needed.
- Actively participates in a variety of internal hospital-wide conferences/committees, whereby decisions/recommendations affect length of stay, discharge planning, and reimbursement.
- Implements and monitors compliance with State, Federal and other regulatory agencies. Responsible for dissemination of standards and regulations from reimbursement agencies.
- Concurrently monitors medical records for accuracy, over utilization, underutilization and inefficient scheduling of services.
- Monitors and provides input in discharge planning as member of health teams.
- Investigates and recommends transfers of patients/residents who require a level of care change.
- Reviews and extracts relevant information from the medical record for insurance reimbursement. Assist specific departments when documentation problems arise.
- Initiates, updates and finalizes utilization review worksheets to reflect utilization review functions and identify need to send medical data to primary payor.
- Works closely with physicians and other health care team members to interpret level of care requirements and insurance regulations.
- Responsible for telephone pre-certification and recertification of LTC Center patients/residents with 3rd party payors.
- Formulates and distributes agenda for Chairman of the Utilization Management Committee. Responsible for compiling Utilization Management minutes.
- Responsible for obtaining medical statistics for Performance Improvement.
- Issues organization initiated notices of non-coverage and in accordance with insurance guidelines. Reviews medical record, initiates and formulates complex correspondence for appeal and reconsideration of denied cases. Keeps MDS Coordinator informed of the status of the appeals.
- Works closely with Admitting, Patient Accounting, Health Information Management and Social Work Department to facilitate reimbursement and quality care.
- Remains current with regards to the delivery of patients/resident care. Investigates patient/resident medical changes by review of record and observation and recommends transfer of those who require a change in level of care.
- Manages timely disbursement of medical information to the Patient Accounting Department for reimbursement.
- Performs LOCD determinations, tracking and documentation.
- Performs other related duties that may become necessary to ensure compliance with current State, Federal and Regulatory Agency guidelines.
- Regular and punctual attendance is required.
