Avalon Health Care is seeking an experience MDS Nurse Leader to join our CA Regional Team as our Regional Resident Assessment Director!
The Regional Resident Assessment Director assures the management of the Medicare, Managed Care and Medicaid reimbursement system for a region-specific number of skilled nursing facilities. This position reports directly to the Regional Vice President.
This position is responsible for regulatory compliance and quality improvement efforts, in order to attain the appropriate Medicaid/Medicare reimbursement possible for assigned facilities. The Regional Resident Assessment Director ensure that the services offered exceed federal, state, and company standards, and serve as a role model for ethical business practices according to standards.
Essential Duties and Responsibilities:
1.) Implement and direct Medicare and Medicaid auditing and systems review during routine facility visits.
• Admission pre-screening
• Admission documentation requirements
• Financial documentation requirements
• Clinical documentation
• Strategic selection of assessment reference dates
• MDS accuracy
• ADL score tracking
• Denials management
• RUGs management
• Therapy implementation and documentation
2.) Provide Interdisciplinary Team Training, Including in-depth orientation of RA Director/Coordinator
• Role and responsibility of the facility Resident Assessment Director/Coordinator
• Provide education on the software utilized to complete and transmit the MDS
• MDS and PPS training of all staff involved with the RAI process
• Documentation requirements
• RUGs groups
• Admission strategies
• Managed Care contracts and updates
• HIPPS coding
• Consolidated billing
• Update facilities on trends, developments, concepts and techniques in the Medicaid and Medicare fields that affect reimbursement services
• Engage facility management team in problem solving process to identify improvement opportunities and achieve solution
• Facilitate effective well-organized daily PPS meetings, establish productive objectives and follow through with action plans
• Evaluate performance of facility-based staff and make recommendations regarding staff assignments, assessment procedure and reimbursement systems. Ongoing evaluation of the effectiveness of reimbursement staff
• Fee schedules
• Industry updates and regulation changes
3.) Understand and assist facilities in Financial Analysis related to the RAI process
• Rate projections
• Vendor contract strategies
• Monthly RUGs distribution
• Length of stay analysis
• Assist in Part B program development
• Assist in budget process.
4.) Understand and assist facilities with Clinical Analysis related to the RAI process
• Monitor daily PPS meeting during facility visits
• Review Month end Triple Check prior to billing
• Review Nursing documentation
• Minimum of Associates Degree in Nursing or Bachelors Degree in healthcare-related field.
• Minimum of 5 years of experience in long term care.
• Regional leadership experience preferred
• Proven leadership and supervisory experience
• Proven knowledge of quality improvement processes with an emphasis on claim coding, MDS and associated clinical documentation auditing and correction process.
• Excellent oral and written communication skills.
• Computer skills.
• Current licensing and credentials as required.
• Up to 80% travel