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Case Mix Coordinator RN HCC

PruittHealth Covington Full-Time
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Responsible forcoordinating assessments for each resident including Resident AssessmentInstrument (RAI), CAAs and Care Plan. This includes all admission, quarterly,annual and significant change assessments as well as any required Medicareassessment. Responsibilities include maintaining accurate and timelyassessments, meeting all automation requirements as defined by the regulations,facilitating a functioning interdisciplinary team, maintaining roster and census reports and monitoring of all reportsgenerated by this department.

1. Facilitates communication between nursingcenter departments and patient/family members to provide an effectiveassessment/care plan process.
2. Establishes open lines of communication withconsultants. Have effective interviewing skills for the purpose of collectinginformation from patients, families, and staff members.
3. Conduct/coordinate patient (or family)interviews for assessment purposes.
4. Evaluates each patient’s condition andmedical data to determine special needs, or the need to amend the admissionassessment.
5. Has a comprehensive understanding of nursingresource material and understands how to
incorporate suchinformation into care plans [i.e., nursing journal articles that relate tospecific patient care topics (bowel& bladder retraining, restraintassessment & use, fall assessments, skin assessments, etc.)]
6. Establishes open lines of communication withinterdisciplinary team members in order to provide a comprehensive and holisticpatient care plan.
7. Maintains schedule of assessment/care planmeetings. Coordinate schedule with nursing
center staff and others(family, therapists’ etc.) to provide for appropriate participation.
8. Ensures care is provided in accordance withpatient’s wishes. Coordinate the development of a care plan (preliminary andcomprehensive) for each patent that identifies problems/needs, appropriate interventions,measurable goals, and assign responsibilities for delivery of care.
9. Provides that patient assessment and careplans are completed in a timeframe that is in accordance with currentregulations.
10. Facilitateseducation to inform associates of the patient’s care plan prior toadministering
11. Coordinates thereview of each assessment/care plan for accuracy (including timelinessappropriate signatures and dates etc.)
12. Signs and dateseach assessment to certify its completion.
13. Monitors the RAIprocess for accuracy according to the RAI guidelines and other acceptedstandards.
14. Educates theinterdisciplinary team and other staff members as needed in the RAI process.
15. Conducts physicalassessment of patient to provide accurate RAI process.
16. Assesses patientneeds and make recommendation for skilled rehabilitative services as well asmaintenance therapy services.
17. Conducts patientcare conferences. May be required to direct and implement nursing serviceeducational programs in reference to patient assessment and care.
18. May be required tomeet with all shifts for the purposes of planning, coordinating, andimplementing patient care.
19. Assists incompliance with Federal, State, and Local regulations in relation to scheduling,performing, and implementing patient care plans.
20. May be required tomake management reports and participate in special assignments.
21. Complies withspecific time limitations in terms of scheduling and planning patient care.
22. Supervises CertifiedNurse Assistant.
23. Be highly involvedin determining skilled level of care for Medicare residents and procuringrequired
Medicare-specificdocumentation; be responsible for physician certification of a skilled level ofcare throughout the Medicare stay; be involved in making eligibilitydeterminations
24. Coordinate carewith case managers for residents utilizing managed care, health maintenance
organizations (HMOs),commercial insurance, and other alternate payment models.
25. Serve as a memberof the quality assessment and assurance (QAA) and/or the quality assurance andperformance improvement (QAPI) committees.
26. Work closely with Admissions director/Senior Nurse Navigator, Hospital medical records, and physicians to obtain accurate and complete documentation to support ICD-10-CM diagnosis
coding and surgicalprocedures. and physicians to obtain accurate and complete documentation tosupport ICD-10-CM diagnosis coding and surgical procedures.
27. Audit and improve staff education/competency as needed to ensure accurate and timely
completion ofsupporting documentation and MDS assessments.
28. Participate in care conferences, dischargeplanning, training, caregiver training, and the provision of resources asneeded
29. Ensure that theresidents’ rights to fair and equitable treatment, self-determination,individuality,
privacy, property, and civil rights, including the right to wage complaints, are always well- established and maintained.

• Participates in center/agencysurveys (Licensure / JCAHO) and any subsequently required reports.
• Attends and participates incontinuing educational programs to keep abreast of changes in your field aswell as to maintain current license/certification, as required.
• Attend and participate in mandatoryin-services.
• Honors patients/residents’ rights tofair and equitable treatment, self-determination, individuality, privacy,property and civil rights, including the right to wage complaints.
• Complies with corporate compliance program.
• Reports job-related functions/tasksthat involve occupational hazards including exposure to blood and body fluidsand others as necessary.
• Follows established safetyregulations, to include fire protection & prevention, smoking regulations,infection control, etc.
• Follows established safetyprocedures when performing tasks and/or working with equipment.
• Performs other related duties as necessaryand as directed by supervisor.
• Must have knowledge of Medicare andMedicaid programs and requirements. Computer literacy is necessary.


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.

Current, active and unrestricted RegisteredNurse (RN) licensure in state of practice.

ADDITIONAL QUALIFICATIONS: (Preferredqualifications)
Nursing service administration experience andRAI experience preferred.

Job: Nursing
Primary Location: Georgia-Covington
Schedule: PRN
Shift: 1st Shift
Job Posting: Oct 15, 2019, 7:24:56 PM

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