Regency Integrated Health Services
REGIONAL CARE MANAGEMENT SPECIALIST - REGISTERED NURSE
Regency Integrated Health Services, Victoria, Texas, United States, 77904
Regency Corporate Office - Victoria, TX 77901 Overview Position Type:
Full Time
Category: breakfasts Overview
Provides extensive training, analysis, advice, and consultation to the facilities and regional teams within his/her area of responsibility. Ensures compliance with federal and state regulations, as well as company policy and procedures regarding state Case Mix/Medicare and Managed Care payment systems. Monitors, consults, and make effective recommendations for changes and modifications to existing facility processes, systems, policies, and practices which langt efficiently, effective and compliant state Medicaid/Medicare/Managed Care payment performance. Manages the activities நடத்தல்தை ofNHACare Management Specialist in the facilities. միկերներ all RIHS policies and procedures. Essential Job Duties and Responsibilities
Provides consultation, training, and support concerning the Medicare, Managed Care and state Case Mix payment systems for the assigned area. Analyzes systems and processes כמעט that federal and state regulations as well as company policies and procedures are followed. Promotes compliance by performing periodic audits of MDS assessments, supporting documentation, and other relevant data. Participates, when necessary, in the pre-admission process to ensure essential information needed for MDS/Case Mix optimization and medical necessity determination is obtained from the referral source(s). RecognizesDesde ads advises, and promotes facility best practices and systems for dealing with state Case Mix/Medicare, and Managed Care payment systems. Studies, analyzes, and reports period over period information and systems to identify trends and deviations from expected results in Medicare RUG scores, Managed Care and state Case Mix Index and takes appropriate actions. Works in conjunction with regional teams to resolve issues effecting deviations from expected results. Recommends changes and performs follow-up to ensure that those recommendations are effectively implemented and monitored for appropriateness. Regularly communicates to management outside the facility on recommendations made to facility management to ensure proper implementation and follow-up. Serves as a liaison between state and organizations related to the state Case Mix process, including electronic submission and state MDS requirements related to state payment. Attends state sponsored Case Mix training as indicated. Attends regional meetings, as well as company conference calls and trainingas appropriate. Works with regional team to coordinate training to facility team members on state Case Mix/Medicare/Managed Care payment systems. Completes Facility Site Visits and Quality Review audits as directed, evaluating Case Mix, RAI/Medicare samenleving, rate optimization, Medicare LOS, ADL and Skilled note documentation, Care Management Meetings, and Quality Measures and communicates findings to facility leadership and regional team. Identifies facility and regional education needs and provides small/large group and individual training as needed. Assists in the recruitment/interview process for Care Management vacancies. Participates in daily Case Management, weekly Level of Care meeting, monthly Triple Check and other meetings per RIHS policy. Assists in the preparation and(pkg submission of any Additional Development Requests (ADRs), Reconsideration and Administrative Law Judge (ALJ). Functions as an RAI and Clinical Reimbursement resource to the facility staff and regional team. Other Duties
Maintains current knowledge of reimb illnesses regulations. Maintains data in an organized, easily retrievable manner. Maintains good personal hygiene and follows dress code requirements. Communicates regularly with the Director of Care Management to discuss identified clinical reimbursement issues. Other duties as缴 assigned or needed. Must be willing to commute throughout Houston and nearby areas. Qualifications
Three to five years of clinical experience in a long term care setting, which includes supervisory, administrative, or consultative capacities. Current knowledge of computer technology and systems. Ability to work independently with minimal supervision and guidance. Proven written and oral communication skills. Proven decision making and analytical skills. Basic understanding of rehab, dietary, social services, and recreational services. Key Competencies
Analytical reasoning Logical reasoning Problem solving Time management Organizational skills Research skills Language Skills
Must possess excellent verbal and written communication and presentation skills. Other Requirements
Must possess superior clinical assessment and documentation skills. Must demonstrate strong interpersonal skills and ability
Must be willing and able to travel extensively and maintain a valid driver’s license. Must meet all local health regulations and pass post-employment physical exam, if required. Must be capable of performing the Essential Job Duties of the job, with or without reasonable accommodation.
Educational/Training Requirements
RN/LVN or completion of a Bachelor’s Degree in a health care or related field, consistent with the duties to be performed. Extensive knowledge of MDS and back-up documentation required and extensive knowledge of state grouper and calculator field relative to MDS and state payment. Extensive knowledge of Medicare reimbursement, RUG IV system, compliance and eligibility. Competency in computer technology and systems needed to manage Medicare/state Case Mix systems. Competency with standard office software applications as well as sort software applications related to MDS/RAI processes.
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Full Time
Category: breakfasts Overview
Provides extensive training, analysis, advice, and consultation to the facilities and regional teams within his/her area of responsibility. Ensures compliance with federal and state regulations, as well as company policy and procedures regarding state Case Mix/Medicare and Managed Care payment systems. Monitors, consults, and make effective recommendations for changes and modifications to existing facility processes, systems, policies, and practices which langt efficiently, effective and compliant state Medicaid/Medicare/Managed Care payment performance. Manages the activities நடத்தல்தை ofNHACare Management Specialist in the facilities. միկերներ all RIHS policies and procedures. Essential Job Duties and Responsibilities
Provides consultation, training, and support concerning the Medicare, Managed Care and state Case Mix payment systems for the assigned area. Analyzes systems and processes כמעט that federal and state regulations as well as company policies and procedures are followed. Promotes compliance by performing periodic audits of MDS assessments, supporting documentation, and other relevant data. Participates, when necessary, in the pre-admission process to ensure essential information needed for MDS/Case Mix optimization and medical necessity determination is obtained from the referral source(s). RecognizesDesde ads advises, and promotes facility best practices and systems for dealing with state Case Mix/Medicare, and Managed Care payment systems. Studies, analyzes, and reports period over period information and systems to identify trends and deviations from expected results in Medicare RUG scores, Managed Care and state Case Mix Index and takes appropriate actions. Works in conjunction with regional teams to resolve issues effecting deviations from expected results. Recommends changes and performs follow-up to ensure that those recommendations are effectively implemented and monitored for appropriateness. Regularly communicates to management outside the facility on recommendations made to facility management to ensure proper implementation and follow-up. Serves as a liaison between state and organizations related to the state Case Mix process, including electronic submission and state MDS requirements related to state payment. Attends state sponsored Case Mix training as indicated. Attends regional meetings, as well as company conference calls and trainingas appropriate. Works with regional team to coordinate training to facility team members on state Case Mix/Medicare/Managed Care payment systems. Completes Facility Site Visits and Quality Review audits as directed, evaluating Case Mix, RAI/Medicare samenleving, rate optimization, Medicare LOS, ADL and Skilled note documentation, Care Management Meetings, and Quality Measures and communicates findings to facility leadership and regional team. Identifies facility and regional education needs and provides small/large group and individual training as needed. Assists in the recruitment/interview process for Care Management vacancies. Participates in daily Case Management, weekly Level of Care meeting, monthly Triple Check and other meetings per RIHS policy. Assists in the preparation and(pkg submission of any Additional Development Requests (ADRs), Reconsideration and Administrative Law Judge (ALJ). Functions as an RAI and Clinical Reimbursement resource to the facility staff and regional team. Other Duties
Maintains current knowledge of reimb illnesses regulations. Maintains data in an organized, easily retrievable manner. Maintains good personal hygiene and follows dress code requirements. Communicates regularly with the Director of Care Management to discuss identified clinical reimbursement issues. Other duties as缴 assigned or needed. Must be willing to commute throughout Houston and nearby areas. Qualifications
Three to five years of clinical experience in a long term care setting, which includes supervisory, administrative, or consultative capacities. Current knowledge of computer technology and systems. Ability to work independently with minimal supervision and guidance. Proven written and oral communication skills. Proven decision making and analytical skills. Basic understanding of rehab, dietary, social services, and recreational services. Key Competencies
Analytical reasoning Logical reasoning Problem solving Time management Organizational skills Research skills Language Skills
Must possess excellent verbal and written communication and presentation skills. Other Requirements
Must possess superior clinical assessment and documentation skills. Must demonstrate strong interpersonal skills and ability
Must be willing and able to travel extensively and maintain a valid driver’s license. Must meet all local health regulations and pass post-employment physical exam, if required. Must be capable of performing the Essential Job Duties of the job, with or without reasonable accommodation.
Educational/Training Requirements
RN/LVN or completion of a Bachelor’s Degree in a health care or related field, consistent with the duties to be performed. Extensive knowledge of MDS and back-up documentation required and extensive knowledge of state grouper and calculator field relative to MDS and state payment. Extensive knowledge of Medicare reimbursement, RUG IV system, compliance and eligibility. Competency in computer technology and systems needed to manage Medicare/state Case Mix systems. Competency with standard office software applications as well as sort software applications related to MDS/RAI processes.
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