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Responsible for the care of an admission to the medical care facility(MCF) from the initial assessment of the level of care required, to the coordination of the care with the staff, and to the maintenance of the care records. Ensures Medicare compliance and accurate completion of the M.D.S. Serves as liaison between the MCF, the payer, and the corporate office. Coordinates the restorative nursing care program by screening the residents, setting goals for the resident, updating the goals as needed, supervising and educating the staff who provide the restorative care.
Essential Job Functions
• Assesses the level of care on all new admissions and monitors for changes in the level of care. Ensures Medicare and other third party payer compliance by overseeing the documentation of the skilled level of care and communicating any changes in care levels to the staff.
• Attends daily “stand up” meetings and facilitates the care planning conferences.
• Coordinates interdisciplinary participation in completing the M.D.S. within required time frames. Responsible for monitoring, reviewing, and transmitting resident data as part of the electronic transmission of the M.D.S.
• Maintains accurate records of resident assessments that are due and communicates with the other departments.
• Teaches staff to enhance their skill level in providing accurate, timely and appropriate information into the resident assessment system.
• Interacts with residents, families, therapies and physicians regarding resident status.
• Provides current, accurate, and complete clinical information to Medicare or other payer.
• Educates the medical facility staff on contract requirements and preferred providers.
• Negotiates for appropriate continuation of length of stay or extension of services.
• Obtains payer authorizations for recommended treatments, procedures, supplies, and equipment.
• Assists in identifying alternatives to uncovered services and in responding to denials of payment.
• Reviews pre-placement assessments to identify costly treatments, supplies or services.
• Obtains cost information on all facility resources including, but not limited to, medication, supplies, labs x-rays, IVs, specialty equipment, respiratory services and consults. Assists in compiling data on the current resource utilization such as practice patterns within the facility that contribute to high resource utilization. Performs chart reviews to measure the management of resources.
• Coordinates the restorative care nursing program by screening the residents for appropriate restorative care, setting goals, re-screening to re-evaluate and update goals, and documenting monthly on the resident’s progress.
• Communicates with the physicians and therapists for orders and referrals as required.
• Assists staff in the writing of individual care plans to identify specific problems, goals and restorative approaches.
• Reviews weekly with the CNAs their case loads and their documentation of restorative services to ensure compliance with Medical Assistance and Medicare.
• Provides routine and ongoing staff education in-service in the restorative care process.
• Monitors the proper implementation and effectiveness of the restorative program quarterly.
• May perform other duties as assigned.