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Case Mix Coordinator LPN HCC

Company: Pruitt Health
Location: Columbia
Posted on: December 6, 2019

Job Description:

Job Details Company Overview Description JOB PURPOSE: Responsible for the coordination and completion ofassessments for each patient including the Resident Assessment Instrument (RAI) and CAAs. This includesall OBRA and PPS assessments in compliance with CMS requirements for completionwithin 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 definedby the regulations, accurate reporting of Resource Utilization Groups (RUGs) toall departments, maintaining roster and census reports, participation inpatient care plan development and review. KEY RESPONSIBILITIES: 1. Communicates between nursing center departments and patient/familymembers in order to gather information for an effective completion of the MDSto be used to develop a comprehensive plan of care; establishingmeasurable 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, andinterdisciplinary team. Have effective interviewing skills for the purpose ofcollecting information from patients, families, and staff members. 3. Conducts/coordinates patient (or family) interviews in compliance withRAI process guidelines. 4. Evaluates each patient's condition and medical data to determine specialneeds. 5. Participates in scheduling of assessment/care plan meetings andcoordination of schedule with nursing center staff and others (family,therapists, etc.) to provide for appropriate participation. 6. Maintains compliance in participation with interdisciplinary patientassessment and development of care plans within required timeframes and inaccordance to regulations within LPN Scope of Practice. 7. Participates in the interdisciplinary review of patient assessment/careplan for accuracy (including timeliness appropriate signatures anddates etc.) 8. FollowsRAI process for accuracy according to the RAI guidelines and other acceptedstandards. 9. Participate in education with the interdisciplinary team and other staffmembers as needed in the RAI process. 10. Identifies patient needs and makerecommendation for skilled rehabilitative services as well as maintenancetherapy services. 11. Participates in patient care conferences. Maybe required to participate in nursing service educational programs in reference to patientassessment and care. 12. Assists in maintaining compliance withfederal, state, and local regulations. 13. Be highly involved in determining skilledlevel of care for Medicare residents and procuring required Medicare-specificdocumentation; be responsible for physician certification of a skilled level ofcare throughout the Medicare stay; be involved in making eligibilitydeterminations 14. Coordinate care with case managers forresidents utilizing managed care, health maintenance organizations (HMOs),commercial insurance, and other alternate payment models. 15. Serve as a member of the quality assessmentand assurance (QAA) and/or the quality assurance and performance improvement(QAPI) committees. 16. Work closely with Admissions director/SeniorNurse Navigator, Hospital medical records, and physicians to obtain accurate and completedocumentation to support ICD-10-CM diagnosis coding and surgical procedures. 17. Auditand improve staff education/competency as needed to ensure accurate and timelycompletion of supporting documentation and MDS assessments. 18. Participate in care conferences, discharge planning, training, caregivertraining, and the provision of resources as needed 19. Ensure that the residents' rights to fair andequitable treatment, self-determination, individuality, privacy, property, andcivil rights, including the right to wage complaints, are always well-established and maintained. KNOWLEDGE, SKILLS, ABILITIES: - Hasa comprehensive understanding of RAI guidelines and CMS regulation related tocompletion of MDS and care plan. - Hasa comprehensive understanding of nursing resource materials [i.e., nursingjournal articles that relate to specific patient care topics (bowel & bladder retraining, restraint assessment & use, fall assessments, skinassessments, etc.)] - One yearprofessional nursing experience in a SNF setting, RAI experience preferred. - Computerliteracy necessary. - Possessstrong leadership and communication skills. - Musthave knowledge of Medicare and Medicaid programs and requirements. - Computerliteracy is necessary. - Participatein center/agency surveys (Licensure/JCAHO) and any subsequently requiredreports. - Attendand participate in continuing educational programs to keep abreast of changesin your field as well as to maintain current license/certification as required. - Attendand participate in mandatory in-services. - Honorpatients/residents' rights to fair and equitable treatment, self-determination,individuality, privacy, property and civil rights, including the right to wagecomplaints. - Complywith corporate compliance program. - Reportjob-related functions/tasks that involve occupational hazards includingexposure to blood and body fluids and others as necessary. - Followestablished safety regulations, to include fire protection & prevention,smoking regulations, infection control, etc. - Followestablished safety procedures when performing tasks and/or working withequipment. - Performother related duties as necessary and as directed by supervisor. - Participate in healthcare center QAPI initiatives. - Maintaincompliance with healthcare center policies and processes. - Communicatewell with patients/residents/clients and family members providing warm andfriendly greeting and an approachable attitude to families, visitors,patients/residents/clients and responds to expressed concerns whiledisplaying a helpful, caring demeanor. Answer questions when appropriate in aprofessional manner. Qualifications MINIMUM EDUCATION REQUIRED: Nursing Degreefrom an accredited college or university or is a graduate of anaccredited/approved LPN program. MINIMUM EXPERIENCE REQUIRED: Minimum one-yearexperience with RAI process. MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW: Current andunrestricted Licensed Practical Nurse (LPN) licensure in state of practice. Job: Nursing Primary Location: South Carolina-Columbia Schedule: PRN Shift: 1st Shift Job Posting: Nov 12, 2019, 1:44:59 PM Recommended skills Medicare Implantable Cardioverter Defibrillator Medicaid Scheduling Managed Care Licensed Practical Nurse

Keywords: Pruitt Health, Columbia , Case Mix Coordinator LPN HCC, Healthcare , Columbia, South Carolina

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