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Case Mix Director RN, Rockingham at PruittHealth

Case Mix Director RN, Rockingham

PruittHealth Rockingham, NC Full-Time
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The primarypurpose of this position is to provide management of resident care as relatedto the Resident Assessment Instrument (RAI) process, in accordance with federaland state regulations, facility policy and as directed by the Administrator.Responsible for coordination and completion of assessments for each patientincluding the Resident Assessment Instrument (RAI), CAAs and Care Plan. Thisincludes all OBRA and PPS assessments in compliance with CMS requirements forcompletion. Responsibilities include scheduling and maintaining accurate andtimely assessments, meeting all automation requirements as defined by theregulations, facilitating a functioning interdisciplinary team, maintainingroster and census reports, monitoring of all reports generated by thisdepartment, facilitating patient care plan development and review, providingoversight for department LPN staffing in compliance within the guidelines ofthe state nursing scope of practice, and fosters adherence to company policyand processes.

1.  Supervises Case Mix Coordinators, monitoring performance, to identifyeducational needs and providing education and/or coordinating education withClinical Reimbursement Consultant.
2.   Assumeskey leadership role in mentorship and education for the Case Mix Coordinator toensure competency and retention.
3.  Facilitates communication between nursing center departments andpatient/family members in
order to carry out an effective assessment todevelop a comprehensive plan of care; establishing measurable goals, appropriateintervention, and assignment of responsibility in delivery of care, in
accordance with the patient’s wishes.
4.  Establishes open lines of communication with consultants. Effectivelyinterview for the purpose of collecting information from patients, families,and staff members.
5.  Conducts/coordinates patient (or family) interviews for assessmentpurposes.
6.   Evaluates each patient’s condition andmedical data to determine special needs, preferences, or the need to amend theadmission assessment.
7.  Maintains schedule of assessment/care plan meetings. Coordinate schedulewith nursing center
staff and others (family, therapists, etc.) toprovide for appropriate participation.
8.  Provides oversight and compliance in the patient assessment anddevelopment of care plans within required timeframes and in accordance toregulations.
9.  Facilitates proactive communication with medical directors, primary carephysicians (PCPs),
specialists, auxiliary providers, case managers,and nurses for development of comprehensive plans of care and coordination ofeffective and efficient delivery of patient care across the care
10. Facilitates education to inform caregivers ofthe patient’s care plan prior to administering care.
11. Coordinates the review of each assessment/careplan for accuracy (including timeliness appropriate signatures and dates etc.)
12. Monitors the RAI process for accuracyaccording to the RAI guidelines and other accepted standards.
13. Educates the interdisciplinary team and otherstaff members as needed in the RAI process.
14. Conducts physical assessment of patient toprovide accurate RAI process.
15. Assesses patient needs and make recommendationfor skilled rehabilitative services as well as maintenance therapy services.
16. Conducts patient care conferences. May berequired to direct and implement nursing service
educational programs in reference to patientassessment and care.
17. Assists in maintaining compliance withfederal, state, and local regulations.
18. 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
19. Coordinate care  with  case managers  for  residents utilizing  managed  care, health  maintenance organizations(HMOs), commercial insurance, and other alternate payment models.
20. Serve as a member of the quality assessmentand assurance (QAA) and/or the quality assurance and performance improvement(QAPI) committees.
21. Work closely  with  Admissions director/Senior  Nurse  Navigator, Hospital  medical  records, and
physicians to obtain accurate and completedocumentation to support ICD-10-CM diagnosis coding and surgical procedures.
22.  Auditand improve staff education/competency as needed to ensure accurate and timelycompletion of supporting documentation and MDS assessments.
23. Participate in care conferences, discharge planning, training, caregivertraining, and the provision of resources as needed
24. Ensure that  the  residents’ rights  to  fair and  equitable  treatment, self-determination, individuality,
privacy, property, and civil rights, including theright to wage complaints, are always well-established and maintained.

•            Hasa comprehensive understanding of RAI guidelines and CMS regulation related tocompletion of MDS and care plan.
•            Hasa comprehensive understanding of nursing resource material and understands howto incorporate such information into care plans [i.e., nursing journal articlesthat relate to specific
patient care topics (bowel& bladderretraining, restraint assessment & use, fall assessments, skin assessments,etc.)]
•   Computerliteracy necessary.
•   Possessstrong leadership and communication skills.
•   Hasability to educate and provide oversight of other partners.
•   Musthave knowledge of Medicare and Medicaid programs and requirements.
•  Knowledge and implementation of Human Resource policies.
•  Participates in center/agency surveys (Licensure/JCAHO) and anysubsequently required reports.
•            Attendsand participates in continuing educational programs to keep abreast of changesin your field as well as to maintain current license/certification as required.
•   Attendsand participate in mandatory in-services.
•            Honorspatients/residents’ rights to fair and equitable treatment, self-determination,individuality, privacy, property and civil rights, including the right to wagecomplaints.
•   Complieswith corporate compliance program.
•            Reportsjob-related functions/tasks that involve occupational hazards includingexposure to blood and body fluids and others as necessary.
•            Followsestablished safety regulations, to include fire protection and prevention,smoking regulations, infection control, etc.
•   Followestablished safety procedures when performing tasks and/or working withequipment.


Nursing Degreefrom an accredited college or university or is a graduate of anaccredited/approved
RN program.
A minimum of one (1) year of experience as asupervisor in a hospital, long-term care facility, or other related health carecenter. Three years of experience with RAI process.
Current, active and unrestricted RegisteredNurse (RN) licensure in state of practice.
ADDITIONAL QUALIFICATIONS: (Preferred qualifications)
Nursing service administration experience andRAI experience preferred.

Job: Nursing
Primary Location: North Carolina-Rockingham
Schedule: Full-time
Shift: 1st Shift
Job Posting: Nov 4, 2020, 2:36:17 PM

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