Managed Care Coordinator jobs in Longview, TX

LongTerm Care facility -

Position Purpose

Conducts and coordinates the completion of required Resident Assessment Instrument (RAI) and is responsible for the implementation and ongoing evaluation of each resident’s comprehensive plan of care.

Required Qualifications

Must possess a current, unencumbered, active license to practice as a registered nurse in this state.

Must have 3 years’ experience as a registered nurse, one of which includes supervisory experience. Experience with MDS completion preferred.

Resident Assessment Coordinator (RAC) training must be completed within six months of hire. RAC Certification is preferred.

Major Duties and Responsibilities

Coordination of the facility’s Resident Assessment Instrument (RAI) process in accordance with state and federal regulations.

Accurate completion of all MDS assessments and any supporting assessments or clinical documentation.

Scheduling and leading interdisciplinary care plan team meetings.

Auditing medical records for the presence of supporting documentation for all items coded on the MDS. Provide education to department heads, physicians, and other staff as needed.

Collaborating with health plans, physicians and the interdisciplinary team for assuring insurance approvals and / or that residents meet eligibility and coverage criteria.

Interpreting rules, regulations and coverage guidelines and acting as primary resource for problem solving in regards to the SNF prospective payment system and quality reporting program.

RAI Coordinator Assigned Tasks

Utilizes the current RAI Manual as a resource during the assessment coding process.

Schedules the Assessment Reference Dates (ARDs) for payment assessments in a manner that accurately captures each resident’s clinical characteristics for payment classification purposes.

Schedules the ARDs for all OBRA (Omnibus Budget Reconciliation Act) assessments daily, monthly, and as needed.

Provides a schedule of ARDs and assessment types weekly and as needed to the interdisciplinary team (IDT) in order to facilitate the timely completion of MDS sections and CAAs (Care Area Assessments) by each discipline.

Communicates with members of the IDT as needed for timely completion of assessments. Expected to report any issues with timeliness to the Administrator.

Transmits assessments in accordance with current regulations. To facilitate timely receipt of validation reports, will transmit as frequently(daily) as necessary to obtain timely validation of MDS acceptance into the Quality Improvement and Evaluation System (QIES) Assessment Submission and Processing (ASAP) System data base.

Confirms transmission files by review and printing of initial and final validation reports.

Corrects any fatal errors immediately and retransmits the assessment until an accepted validation report is received.

Addresses non-fatal errors using the QIES ASAP System MDS 3.0 Provider User’s Guide.

Ensures the Business Office designee receives the initial and final validation report that acknowledges the acceptance of the MDS into the QIES ASAP.

Facilitates the completion and updating of resident care plans with the IDT to reflect each resident’s current needs.

Co mmunicates with the IDT to identify residents in need of a Significant Change in Status assessment, based on criteria in the current RAI manual.

Participates in all resource utilization and / or triple check meetings prior to billing of claims associated with payment assessments.

Assists with admission, discharge, or care of residents as needed.

Attends or participates in continuing education related to the RAI process and related programs. Completes all assigned training and skills competency, as determined by the facility assessment and facility training plans.

Performs administrative duties as assigned, including but not limited to QAPI activities and participation in department or committee meetings.

Last updated : 2024-04-25