Case Mix Coordinator LPN HCC

Company: PruittHealth
Location: Monroe
Posted on: November 19, 2021

Job Description:

Description----PruittHealth is a COVID-19 vaccine-mandated employer. All new Partners are required to provide proof of COVID vaccination or be willing to get vaccinated within 30 days of employment. We will consider medical and/or religious exemptions on a case-by-case basis.--JOB PURPOSE:Responsible for the coordination and completion of assessments for each patient including the--Resident Assessment Instrument (RAI) and CAAs. This includes all OBRA and PPS assessments in compliance with CMS requirements for completion within LPN Scope of Practice as outlined by State Nurse Practice Acts. Responsibilities include scheduling and maintaining accurate and timely--completion of the RAI process, meeting all automation requirements as defined by the regulations, accurate reporting of Resource Utilization Groups (RUGs) to all departments, maintaining roster and census reports, participation in patient care plan development and review.--KEY RESPONSIBILITIES:1.---- Communicates between nursing center departments and patient/family members in order to gather information for an effective completion of the MDS to be used to develop a--comprehensive plan of care; establishing measurable goals, appropriate intervention, and--assignment of responsibility in delivery of care, in accordance with the patient---s wishes.--2.---- Maintains open lines of communication with consultants, supervisors, and interdisciplinary team. Have effective interviewing skills for the purpose of collecting information from patients, families, and staff members.3.---- Conducts/coordinates patient (or family) interviews in compliance with RAI process guidelines.4.---- Evaluates each patient---s condition and medical data to determine special needs.5.---- Participates in scheduling of assessment/care plan meetings and coordination of schedule with nursing center staff and others (family, therapists, etc.) to provide for appropriate--participation.6.---- Maintains compliance in participation with interdisciplinary patient assessment and development of care plans within required timeframes and in accordance to regulations within LPN Scope of Practice.7.---- Participates in the interdisciplinary review of patient assessment/care plan for accuracy--(including timeliness appropriate signatures and dates etc.)8.---- Follows RAI process for accuracy according to the RAI guidelines and other accepted standards.9.---- Participate in education with the interdisciplinary team and other staff members as needed in the RAI process.10. Identifies patient needs and make recommendation for skilled rehabilitative services as well as maintenance therapy services.11. Participates in patient care conferences. May be required to participate in nursing serviceeducational programs in reference to patient assessment and care.12. Assists in maintaining compliance with federal, state, and local regulations.13. Be highly involved in determining skilled level of care for Medicare residents and procuring required Medicare-specific documentation; be responsible for physician certification of a skilled level of care throughout the Medicare stay; be involved in making eligibility determinations14. Coordinate care with case managers for residents utilizing managed care, health maintenance organizations (HMOs), commercial insurance, and other alternate payment--models.15. Serve as a member of the quality assessment and assurance (QAA) and/or the quality assurance and performance improvement (QAPI) committees.16. Work closely with Admissions director/Senior Nurse Navigator, Hospital medical records,and physicians to obtain accurate and complete documentation to support ICD-10-CM--diagnosis coding and surgical procedures.17.-- Audit and improve staff education/competency as needed to ensure accurate and timely completion of supporting documentation and MDS assessments.18.-- Participate in care conferences, discharge planning, training, caregiver training, and the--provision of resources as needed19. Ensure that the residents--- rights to fair and equitable treatment, self-determination, individuality, privacy, property, and civil rights, including the right to wage complaints, are--always well-established and maintained.--KNOWLEDGE, SKILLS, ABILITIES:---------Has a comprehensive understanding of RAI guidelines and CMS regulation related to completion of MDS and care plan.---------Has a comprehensive understanding of nursing resource materials [i.e., nursing journal articles that relate to specific patient care topics (bowel& bladder retraining, restraintassessment & use, fall assessments, skin assessments, etc.)]------- One year professional nursing experience in a SNF setting, RAI experience preferred.------- Computer literacy necessary.------- Possess strong leadership and communication skills.------- Must have knowledge of Medicare and Medicaid programs and requirements.------- Computer literacy is necessary. ---------Participate in center/agency surveys (Licensure/JCAHO) and any subsequently required reports.---------Attend and participate in continuing educational programs to keep abreast of changes in your field as well as to maintain current license/certification as required.------- Attend and participate in mandatory in-services.---------Honor patients/residents--- rights to fair and equitable treatment, self-determination, individuality, privacy, property and civil rights, including the right to wage complaints.------- Comply with corporate compliance program.---------Report job-related functions/tasks that involve occupational hazards including exposure to blood and body fluids and others as necessary.---------Follow established safety regulations, to include fire protection & prevention, smoking regulations, infection control, etc.---------Follow established safety procedures when performing tasks and/or working with equipment.------- Perform other related duties as necessary and as directed by supervisor.------- Participate in healthcare center QAPI initiatives.------- Maintain compliance with healthcare center policies and processes.---------Communicate well with patients/residents/clients and family members providing warm and friendly greeting and an approachable attitude to families, visitors, patients/residents/clients--and responds to expressed concerns while displaying a helpful, caring demeanor. Answer questions when appropriate in a professional manner.------QualificationsMINIMUM EDUCATION REQUIRED:Nursing Degree from an accredited college or university or is a graduate of an accredited/approved--LPN program.--MINIMUM EXPERIENCE REQUIRED:Minimum one-year experience with RAI process.MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:Current and unrestricted Licensed Practical Nurse (LPN) licensure in state of practice.--Job: NursingPrimary Location: North Carolina-MonroeSchedule: Full-timeShift: 1st ShiftJob Posting: Oct 13, 2021, 9:08:42 AM

Keywords: PruittHealth, Rock Hill , Case Mix Coordinator LPN HCC, Healthcare , Monroe, South Carolina