Job Description

Regional Case Manager - Covers Birmingham , Prattville, Wetumpka, Tallassee, Columbiana, Lineville, Hoover)

MDS (minimum data set) experience required

NHS is seeking an experienced Regional Case Manager/MDS Consultant to add to our team of leaders. In this position you will be responsible for the regional coordination, development and completion of the resident assessment process in accordance with the requirements of the Federal and States regulations as well as Company policy and procedure 

Directs the MDS assessment and Medicare related activities of the assigned facilities, ensuring accurate and timely assessments for all residents requiring skilled services. Assists assigned facilities in accurately recording skilled services in the MDS and medical chart and providing rehab services at the highest practicable level for each resident. Provides case management services for certain high-risk Medicare Part A residents to ensure services are provided in accordance with the assessment and the plan of care.

QUALIFICATIONS

1. Must be a Registered Nurse in good standing in the state(s) in which assigned
2. Must be knowledgeable in the areas of general nursing, rehabilitation and restorative nursing, including medical practices in long term care
3. Has a minimum two years experience in long term care with at least one year experience in MDS and Medicare related activities is required.
4. Must have excellent computer skills and a comprehensive understanding of the MDS software program
5. Must have significant experience in nursing assessment and documentation
6. Possesses good organization skills and demonstrated leadership and supervisory skills
7. Possesses good oral communication and presentation skills
8. Must be able to maintain regular attendance
9. Extensive travel required to include overnight travel as needed.

ESSENTIAL JOB FUNCTIONS (With or Without Reasonable Accommodation)

1. Primary Functions:
2. Conducts visits to each facility to determine the effectiveness of the Medicare program processes within the assigned facilities.
3. Reviews the Medicare assessment schedules of facilities at least weekly and ensures timely transmission. Reports any evidence of late assessments to the facility Administrator, Director of Nursing, Regional Administrator, Director of Medicare and Rehabilitation and MDS/Clinical Information Consultant.
4. Conducts audits to ensure accurate completion of all MDS Medicare assessments, following the current regulatory guidelines for assessments.
5. Reviews Medicare Part A MDS assessments to ensure accuracy including; validating therapy minutes, recording of procedures classified as skilled nursing services, accurate ADL scores and diagnoses that support skilled services. Reports discrepancies to the Administrator, Director of Nursing, Regional Administrator, Director of Medicare and Rehabilitation, and MDS/Clinical Information Consultant.
6. Conducts an observation of the resident when an MDS is reviewed for accuracy.
7. Conducts random audits of medical record documentation and the provision of care and services compared to the resident assessment and skilled nursing and rehab services that are being provided. Reports discrepancies to the Administrator, Director of Nursing, Regional Administrator, Director of Medicare and Rehabilitation and MDS/Clinical Information Consultant.
8. Provides consultation to facilities on Medicare eligibility, certification, coverage questions, documentation and utilization and provides training to facility staff as indicated.
9. Reviews Part B therapy utilization and assists facilities with utilization of Part B benefits for residents, along with nursing restorative programs.
10. Partners with Restore Therapy to identify therapy needs for Medicare A & B recipients.
11. Assists the Director of Medicare and Rehabilitation in gathering information for Medicare and Medicaid appeals and denials as requested.
12. During facility visits, conducts an exit interview with the facility Administrator, Director of Nursing, and MDS Coordinator presenting findings from the visit and any recommendations for systems changes.
13. Formulates a visit report for each facility that summarizes issues that were identified during audits and/or visits and systems that were implemented to address the concerns. Reports will be submitted to the facility Administrator, Director of Nursing, Regional Administrator, Director of Medicare and Rehabilitation, Chief Operations Officer (COO), and MDS/Clinical Information Consultant.
14. Assists with the implementation of new NHS and regulatory policies related to the MDS or Medicare programs, in the region’s facilities. Consults with the Director of Medicare and Rehabilitation and MDS/Clinical Information Consultant on the development and revision of policies and procedures, as requested.
15. Participates in daily PPS, Weekly Medicare/Rehab, and monthly Triple Check meetings during facility visits.
16. Assists with the implementation of facility medical record automation efforts as related to the RAI or Medicare process, if requested.
17. Stays current in MDS and Medicare related regulatory changes and revises practices consistent with those changes. Educates facility staff on these changes as directed by Director of Medicare and Rehabilitation and MDS/Clinical Information Consultant.
18. Reviews charts of residents being considered for discontinuation of part A coverage and discusses with facility staff.
19. Serves on committees as assigned.
20. Reviews recommendations of the PDPM group and coordinates with them to identify and implement needed changes and training needs.
21. Other duties as assigned or may become necessary for the successful outcome of a task

We provide the following benefits for you and your family:

1. Blue Cross/Blue Shield health and dental insurance (Low premium and not a high deductible plan)
2. VSP Vision
3. Short and Long Term Disability
4. PTO
5. Best in class employee referral program

We are an equal opportunity employer and value diversity in the workplace

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