Regional Director of Clinical Reimbursement

Required Qualifications

v   Must possess a current, unencumbered, active license to practice as a registered nurse in this state.

v   Must have 3 years’ experience as a registered nurse, one of which includes supervisory experience.   Experience with MDS completion preferred.

v   Resident Assessment Coordinator (RAC) training must be completed within six months of hire.   RAC Certification is preferred.

Major Duties and Responsibilities

Coordination of the facility’s Resident Assessment Instrument (RAI) process in accordance with state and federal regulations.

Accurate completion of all MDS assessments and any supporting assessments or clinical documentation.

Implementation and ongoing evaluation of each 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.

Collaborating with health plans, physicians and the interdisciplinary team for assuring insurance approvals and / or that residents meet eligibility and coverage criteria.

Interpreting rules, regulations and coverage guidelines and acting as primary resource for problem solving in regards to the SNF prospective payment system and quality reporting program.

RAI Coordinator Assigned Tasks

v   Utilizes the current RAI Manual as a resource during the assessment coding process.

v   Schedules the Assessment Reference Dates (ARDs) for payment assessments in a manner that accurately captures each resident’s clinical characteristics for payment classification purposes.

v   Schedules the ARDs for all OBRA (Omnibus Budget Reconciliation Act) assessments daily, monthly, and as needed.

v   Provides a schedule of ARDs and assessment types weekly and as needed to the interdisciplinary team (IDT) in order to facilitate the timely completion of MDS sections and CAAs (Care Area Assessments) by each discipline.

v   Communicates with members of the IDT as needed for timely completion of assessments.   Expected to report any issues with timeliness to the Administrator.

v   Transmits assessments in accordance with current regulations.   To facilitate timely receipt of validation reports, will transmit as frequently(daily) as necessary to obtain timely validation of MDS acceptance into the Quality Improvement and Evaluation System (QIES) Assessment Submission and Processing (ASAP) System data base.

v   Confirms transmission files by review and printing of initial and final validation reports.

v   Corrects any fatal errors immediately and retransmits the assessment until an accepted validation report is received.

v   Addresses non-fatal errors using the QIES ASAP System MDS 3.0 Provider User’s Guide.

v   Ensures the Business Office designee receives the initial and final validation report that acknowledges the acceptance of the MDS into the QIES ASAP.

v   Facilitates the completion and updating of resident care plans with the IDT to reflect each resident’s current needs.

v   Co mmunicates with the IDT to identify residents in need of a Significant Change in Status assessment, based on criteria in the current RAI manual.

v   Participates in all resource utilization and / or triple check meetings prior to billing of claims associated with payment assessments.

v   Assists with admission, discharge, or care of residents as needed.

v   Attends or participates in continuing education related to the RAI process and related programs.   Completes all assigned training and skills competency, as determined by the facility assessment and facility training plans.

v   Performs administrative duties as assigned, including but not limited to QAPI activities and participation in department or committee meetings.

Additional Tasks

v   Treats all residents with dignity and respect.   Promotes and protects all residents’ rights.

v   Establishes a culture of compliance by adhering to all facility policies and procedures.   Complies with standards of business conduct, and state / federal regulations and guidelines.

v   Follows appropriate safety and hygiene measures at all times to protect residents and themselves.

v   Maintains confidentiality of protected health information, including verbal, written, and electronic communications.

v   Reports noncompliance with policies, procedures, regulations, or breaches in confidentiality to appropriate personnel.   Reports any retaliation or discrimination to HR or compliance officer.

v   Reports any allegations of abuse, neglect, misappropriation of property, exploitation, or mistreatment of residents to supervisor and / or administrator.   Protects residents from abuse, and cooperates with all investigations.

v   Reports any occupational exposures to blood, body fluids, infectious materials, and / or hazardous chemicals in accordance with facility policy.

v   Participates in all life safety and emergency drills and trainings.   Fulfills responsibilities as assigned during implementation or activation of the facility’s emergency plan.

v   Reports work-related injuries and illnesses immediately to supervisor.

v   Follows established infection control policies and procedures.

v   As a condition of employment, completes all assigned training and skills competency.

Personal Skills and Traits Desired / Physical Requirements

v   Ability to read, write, speak and understand the English language.

v   Must be a supportive team member, contribute to and be an example of team work.

v   Ability to make independent decisions when circumstances warrant such action.

v   Ability to deal tactfully with personnel, residents, family members, visitors, government agencies / personnel and the general public.

v   Must have patience, tact, and willingness to deal with difficult residents, family and staff.

v   Must be able to relay information concerning a resident’s condition.

v   Must not pose a threat to the health and safety of other individuals in the workplace.

v   Must be able to move intermittently throughout the workday.

v   Meets general health requirements according to facility policy, including medical and physical exams and checking immunity status to various infectious diseases.

v   Ability to work beyond normal working hours and on weekends and holidays when necessary.

v   Ability to assist in evacuation of residents during emergency situations.

v   Ability to bend, stoop, kneel, crouch, perform overhead lifting and perform other common physical movements as needed for the position.

v   May be subject to falls, burns from equipment, and / or odors throughout the day; encounter reactions from dust, tobacco smoke, disinfectants, and other air contaminants.

v   Subject to exposure to infectious waste, diseases and / or conditions which include AIDS, Coronavirus, Hepatitis B, and Tuberculosis.

v   May be subject to hostile or emotional residents, family members, visitors or personnel.

v   Regular attendance is a requirement of this position.

v   Effective verbal and written communication skills and ability to exercise judgement.

v   Intermediate computer skills, including ability to create documents in various programs (Word, Excel, PowerPoint), and navigate electronic medical record systems.

v   Ability to work beyond normal working hours and on weekends and holidays when necessary.

v   Ability to work independently, and to organize, plan, and manage time effectively to complete assignments.

v   Positive interpersonal relationship skills, including with persons of all ages and cultures.

v   Current awareness of relevant regulations and standards of care.

Compliance as a Condition of Employment and Performance Appraisal

Agreement to abide by all standards, policies, and procedures of the facility, including the facility’s compliance and ethics program, is a condition of employment.   Compliance will be a factor in evaluating job performance.   Violations, including failure to report violations, will result in disciplinary action, up to and including termination.

This job description is intended to convey the general scope of the major duties and responsibilities inherent in this position.   Other tasks not listed here may be assigned by the Administrator.   Periodic revision may be necessary to reflect changes in expectations placed on long term care by the Department of Health and Human Services (HHS).   This job description will be reviewed and / or revised by the Administrator annually and as needed.

Individual performance will be evaluated using the following scale :

1.       Unsatisfactory : Achieves results which are far less than the standards identified for the performance factors rated.

2.       Needs Improvement : Achieves results which are less than the standards identified for the performance factors rated.   Exhibits the potential to become a competent performer.   May be new to job or need skill development.

3.       Meets Standards : Achieves results which meet the standards identified for the performance factors rated.   This rating is the expected level of performance.

4.       Exceeds Standards : Achieves results which usually exceed the standards identified for the performance factors rated.

Reasonable Accommodation Statement

Consistent with the Americans with Disabilities Act (ADA) and [insert state civil rights law], it is the policy of [Facility Name] to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship.   The policy regarding requests for reasonable accommodation applies to all aspects of employment, including the application process.   If reasonable accommodation is needed, please contact [include name and / or department, telephone, and e-mail address].

Equal Opportunity Employer Statement

We are an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.

EMPLOYEE ACKNOWLEDGEMENT

I have read the above job description and understand the requirements and expectations of the position of MDS / CRC Coordinator at [Name of Facility] .

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Employee’s Signature                                                                    Date

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Administrator’s Signature                                                                             Date