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Medicare Nurse Case Manager (RN)

Company: Whispering Pines
Location: Shreveport
Posted on: March 27, 2020

Job Description:

Medicare Nurse Case Manager (RN)ATTENTION APPLICANT:-- OUR FACILITY IS CURRENTLY LOCATED IN PLAIN DEALING, LA. --HOWEVER, WE WILL BE MOVING TO OUR TO OUR NEW FACILITY, IN BOSSIER CITY, OCTOBER 2020!!!-- APPLICANT MUST BE PREPARED TO WORK AT THE NEW FACILITY WHEN IT OPENS.The Medicare Nurse Case Manager ("MNCM") coordinates the nursing aspect of the Medicare program, including screen for skilled care, pre-admissions, admissions, nursing documentation and evaluations for continued stay to ensure an effective Medicare program.-- The NMCM is responsible for monitoring assignment of patients to Resource Utilization Groups (RUGs); utilizing resources used in treatment; assigns RUGs payment periods associated with the Minimum Data Set (MDS) schedules; works with the Billing Department to coordinate patient services utilization, RUGs payment categories and UB 04 coding; and develops and maintains on-going MDS schedules for each patient; communicates with physicians/nurses/CNAs/coworkers/interdisciplinary team members-- and families, as appropriate, regarding resident's clinical condition; responds timely and accurately to changes in resident's condition or response to treatment by initiating assessment action plan; and performs general nursing duties as required to-- ensure that the highest degree of quality care is maintained at all times and in accordance with the established policies, procedures and standards of CommCare Corporation, and any other tasks or responsibilities assigned. The MNCM follows a flexible work schedule to cover weekend admissions.ESSENTIAL JOB DUTIES------------ A.-- LEADERSHIP FUNCTIONS-- -------------------- ------------------ --Manages and collaborates with the MDS Team on pre-admission screening, assignment of observation and look-back periods; informs the interdisciplinary team regarding changes in look-back periods for the MDS completion including the implementation of a "significant change" MDS/plan of care processes.Assigns the admission RUG category for payment for the initial five day Medicare MDS in collaboration with the MDS Team.Determines the RUG categories of Medicare payments for patients based upon the MDS assessments and in collaboration with the MDS team.Demonstrates an ability to be flexible, organized, and function under stressful situations.Treats residents and their families with respect and dignity; ensures resident confidentiality and privacy.Maintains a good working relationship both with all departments and with contacts from referring facilities and agencies.Oversees resident care cost, acquisition and/or rental of medical equipment and supplies used with residents as ordered by the physician and noted in the plan of care.Attends meetings as required to include Medicare staff meetings, therapy meetings, and care plan meetings for skilled residents.Sees that supplies are available in proper quantities, that equipment is available in good condition and that personnel using such supplies and equipment know where such are to be found and know the proper care and use.Gives guidance to personnel as needed, valuates performance, discusses progress and needs for improvement and prepares evaluations of performance as directed.-- ----B. MEDICATION AND TREATMENT ADMINSTRATION FUNCTION--Makes rounds of Medicare residents at least daily.Performs a nursing physical and psychosocial MDS assessment on all residents and reassessments as per the MDS scheduled requirements unless these are assigned to other clinical disciplines for completion.Demonstrates an ability to assist physicians with procedures and performs services requiring technical and manual skills.Demonstrates ability to directly perform treatments and provide services to the level of licensure.Knowledge of medication and their correct administration based on age of the resident and his/her clinical condition.Assists with discharging residents.Assists the DON in other duties as directed.-- -------- C. COORDINATION OF CARE FUNCTIONSWorks closely with admissions to assess all inquiries for possible Medicare admissions.Visits or arranges for the visit of an appropriate clinical representative to pre-screen potential residents on-site at the referring facility, agency, or hospital.Interacts with discharge planners and staff from referring facilities, agencies and hospitals to prescreen potential residents for admission and readmission to the facility.Establishes individual MDS schedules and coordinates assessment activities across clinical disciplines for each resident following regulatory requirements.Initiates and coordinates patient discharge plan upon admission to the facility in collaboration with the social services, admissions, clinical team, patient and family.Coordinates care planning with Assessment Nursing for skilled residents.DOCUMENTATION FUNCTIONS--Screens all new admits and readmissions for skilled care in accordance with facility policies and -------------------- --Responsible for skilled nursing documentation on Medicare residents, either through actual documentation or audits.Responsible for all required nursing documentation for Medicare nursing to include any other record keeping required by the program for nursing.Assesses Medicare residents for continued stay on continuous basis and tracks remaining days inEnsures the MDS's are encoded, edited, locked and electronically transmitted within the required time --------------------Reviews and sends the MDS scores and RUGs categories to the billing office within the required timePrepares requests for issuance of denial letters on admission and readmission.Demonstrates basic computer knowledge.E.-- HUMAN RESOURCE MANAGEMENT--Identifies cost variances and recommends cost controls related to resource utilizationConsults other departments as appropriate to provide for an interdisciplinary approach to the resident's care.Coordinates and supervises Medicare resident care activities as necessary to optimize resource utilization.F. EDUCATION AND STAFF DEVELOPMENT--Assists with in-servicing to individualized needs.Completes annual educational requirements per policy.Attends specified staff meetings, reads and returns all information required by immediate supervisor.Occasionally travels for required training and professional meetings.-- -- -- -- -- -- MINIMUM QUALIFICATIONS--A. EDUCATION/EXPERIENCE AND/OR TRAININGThe Medicare Nurse Case Manager must be a graduate of an accredited school of nursing currently registered with the State agency for nursing licensure and hold a valid nursing license to practice in the state of Louisiana.Geriatric nursing experience is preferred.MNCM must have a comprehensive knowledge of general nursing theory and practice and a thorough knowledge of the principles and methods involved in demonstrating techniques and methods of resident care services and assessing resident needs.MNCM must possess the following skills:Ability to be a leader and to manage and motivate people;Ability and desire to work with geriatric residents and their current and prospective needs;Ability to evaluate the geriatric resident's needs and implement systems to meet these needs;Ability to plan and organize the overall plan of care of each resident;Ability to document resident care outcomes.Ability to implement changes as mandated by Federal, State and management suggestions;Ability to follow recommendations as designated by the Nurse Consultant;Ability to maintain effective interpersonal relationships;Ability to function as a cooperative team member with all disciplines in the facility;Willingness to be in the facility working with the staff of each shift at varying times;Ability to read and communicate effectively in English. Additional languages are preferred.Ability to demonstrate good emotional, mental and physical health, having sound judgment and high professional standards;Courtesy in working with residents, families and employees;Ability to maintain a neat, well-groomed and professional appearance at all times.Wears identification while on duty.Ability to report to work on time and as scheduled and to complete work within designated time.Ability to complete in-services and return to work in timely manner.Ability to maintain regulatory requirements.B. OTHER QUALIFICATIONSHas not been excluded from participating in Medicare and Medicaid programs. Maintains eligibility to participate in Medicare and Medicaid programs throughout employment. Capable of providing emergency care as needed for any resident in the facility. Maintains a neat, well groomed appearance at all times. Keeps personal appearance appropriate for resident care.---- Ability and willingness to function appropriately in a disaster or evacuation of the facility. Participate in pre-employment and annual Tuberculosis screening. -------- COMPETENCIES--Concentration/AttentivenessResident FocusedProblem solving/analyticalEthicalIndependent Judgment and DiscretionManage Multiple Projects/TasksStress management/composureReading and understanding comprehensionPHYSICAL DEMANDS--While performing the duties of this job, the employee is regularly required to talk and hear. This position is very active and requires standing, walking, bending, kneeling, and stooping all day. The employee must frequently lift and/or move items over 50 pounds.While performing the duties of this job, the employee is regularly required to talk and hear.-- Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus. ----Must be able to lift residents according to each resident's needs, some residents may need 100% assistance and others may only need limbs lifted.-- Must be able to lift various equipment for residents' needs.-- Expected to lift up to 300 lbs, with assistance, using equipment or other personnel to assist in the lifting.-- ----WORKING CONDITIONS--Work will be mostly indoors, with frequent to occasional outdoor requirements.Adequate lighting and ventilation is provided in work areas.May be exposed to communicable diseases and/or body fluids, medical preparations, toxic substances.Sits, stands, bends and moves intermittently during working hours.Subject to interruptions.May encounter hostile and emotionally upset individuals through communication and involvement with residents, family members, staff members, visitors, and the public,NH/HH schedules reflect the needs of the residents and the NH/HH and will be periodically evaluated, which may require work outside of normal duties and working hours, such as on weekends and holidays, or assignment to a temporary position. --May be subject to falls, burns from equipment, infectious and communicable diseases, body fluids, medical preparations, hazardous or toxic substances, odors, and other hazards to health, throughout the shift or time worked. --PERSONAL PROTECTIVE EQUIPMENT--Gloves and other protective equipment should be worn when making contact with open wounds, bodily fluids and entering isolation rooms, as recommended in the Infection Control Policy and other policies and procedures.------recblid mubdsku8gbjm20iaezjmm1e3yho3mt

Keywords: Whispering Pines, Shreveport , Medicare Nurse Case Manager (RN), Executive , Shreveport, Louisiana

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