Case Mix Coordinator / Clinical Reimbursement

24 Hours weekly & ( weekdays) We offer the Following: Premium Compensation Great Benefits Package Fun, Family-Like Team, and Atmosphere! Professional Growth & Stability Innovative Training Programs Benefits: 401(k) Dental insurance Health insurance Paid time off Vision insurance Responsibilities The Case Mix Coordinator ensures all UDAs (nursing assessments) are scheduled in PCC prior to the ARDs with specific emphasis on GG and Monitors for timely completion of UDAs. During the Assessment Reference period, the Case Mix Coordinator reviews GG documentation, Coordinates - GG usual performance coding with the Interdisciplinary Team. The Case Mix Coordinator ensures MDS GG coding - usual performance correlates with the team final usual performance and supporting documentation is scanned into PCC under miscellaneous. UDAs to be completed by the IDT include the following BIMS - completed by Social Services PHQ2-9 - completed by Social Services Pain Interview - completed by nursing, MDS- to be scheduled /opened 5 days leading up to the ARD Pain assessment - done by nursing Norton - done by nursing Quarterly/ Annual Assessment includes- (Falls, B&B, Norton, Pain elopement, oral) done by nursing Oral assessment - annual assessment - completed by nursing GG - Admission/ Quarterly/ Discharge/Annually OBRA UDAs populate for admissions/ quarterly and annually - for MCR 5 days/ significant change MDS assessments - ensures the UDA are scheduled/ opened in PCC to support the MDS assessment. Ensure care plans are present for all diagnosis with OBRA assessment for each resident- ensure care plan correlates with MDS with MDS GG section. Ensures order to elevate head of bed is present on MAR/TAR ( you may be the one to set up the order) Ensure respiratory assessments - pre and post Neb assessment and time of administration is scheduled appropriately on the eMar - (You may be the one to set up the PCC order) Ensure Respiratory care plans has "elevate HOB", Resp assessments etc. on the care plan Identify behaviors and ensure Behavior documentation and Behavior care plans are in place to support behavior Add ons. Identify residents meeting the SUD add on criteria and communicate to Social Services and billing - ensure supporting care plan is in place. Audits and collaborate with the MDS coordinator to ensure the MDS assessments have supporting documentation for what is coded on the MDS ( like MMQ supporting documentation). Communicate with Administrative and Nursing leadership if UDAs are not been completed- may be required to complete assessments if nursing is unable to complete due to staffing challenges. May cover for the MDS nurse during vacations/ illness etc Monitors GGs for completion and accuracy minimum 3 x weekly and ensure all Care cards are in place. R esponsible for compliance and reimbursement maximization. Reports directly to the facility Director of Nursing /Administrator and to the Corporate Director of Clinical Operations. Attends the following meetings PDPM/ Behavior Meeting Morning meetings QAPI Minimum Job Skills / Licensure Must hold a valid RN/LPN MA License MMQ Experience preferred Vaccination per CDC and MA DPH guidelines 24 Hours weekly & ( weekdays)

Created: 2024-10-23