Care Management Specialist (19699)
Company: Regency Integrated Health Services
Posted on: May 3, 2021
Responsible for the coordination of the Resident Assessment
Instrument (RAI) process to ensure accurate and timely completion
of resident assessments in accordance with Medicare, Medicaid, OBRA
and other payer program requirements. Ensures assessments
accurately reflect the physical, mental and psychosocial status of
each resident; ensures appropriate documentation to report and
support services provided and assessment accuracy. Communicates
effectively with other members of the interdisciplinary team.
Follows all RIHS policies and procedures.
- Ensures timely, accurate, and complete assessment of the
resident's health and functional status during the entire
- Participates in the pre-admission process to ensure essential
information needed for MDS/Case Mix optimization is obtained from
the referral source(s).
- Ensures accurate and timely completion of all Medicare/Medicaid
case-mix documents to assure appropriate reimbursement for services
provided within the facility.
- Works in collaboration with the facility Director of Rehab to
ensure the most appropriate assessment reference date (ARD) is
utilized for Medicare/Managed Care Assessments.
- Tracks Skilled (MRA/MCO/MCG/MMP) customers utilizing Case
Management Tools to determine continued and appropriate
Medicare/Managed Care eligibility and benefit period through
regular communications with Regional Care Management Specialist,
Business Office and external Case Managers.
- Gathers information needed for Managed Care Utilization Reviews
throughout the resident's stay and communicates this with the
Managed Care organization's Case Manager as required.
- Ensures that additional requirements of the Medicare Program
are met, such as Physician certification and re-certification.
- Performs concurrent MDS review to assure appropriate RUGs
category is achieved through the capture of appropriate clinical
- Participates in the interdisciplinary team process to
communicate opportunities, facilitate efficient and effective care
plan development and management.
- Ensures the accurate and timely completion of all MDS
assessments including PPS, Unscheduled, Admission, Quarterly,
Annual, and Significant Change in compliance with RAI
- Collaborates with the interdisciplinary team to identify
significant change in status and implementation of Significant
Change in Status MDS.
- Maintains an accurate schedule of all MDS assessments to
include the proper reference dates throughout the resident's
- Tracks, records, and analyzes all default days and rectifies if
appropriate. Implements corrective action to prevent further
- Performs Modification/Inactivation of assessments in accordance
with CMS Correction Policy and collaboration with Regional Care
- Conducts regular audit of MDS process including validation of
coding documentation, evaluating outcomes, and utilization of Data
Integrity Audit reports (Point Right) per company policy.
- Ensures the timely electronic submission of all Minimum Data
Sets and secures back-up personnel to complete this process.
- Reviews the Validation reports and ensures that appropriate
follow-up action is taken.
- Reviews Late/Missed assessment reports monthly and addresses
issues as appropriate.
- Reviews QM and SNF QRP reports monthly and ensures that
appropriate follow up action is taken.
- Communicates with the Business Office Manager and Administrator
on a regular basis regarding RUG distribution, default
days/unassigned days, case mix index (if applicable) and their
- Participates in daily Case Management, weekly Level of Care,
monthly Triple Check, and other meetings per RIHS policy. Assists
in the preparation and timely submission of any Additional
Development Requests (ADRs), Reconsideration and Administrative Law
- Functions as an RAI and Care Management resource to the
- Utilizes AIS as annual competency training as well as for
educational resource as needed.
- Assists in the orientation and training of new associates on
the RAI process and ensures the dissemination of any new or updated
materials regarding the RAI and/or Federal and State
- The Care Management Specialist manages the day to day
operations of the department.
- Maintains current knowledge of reimbursement regulations.
- Maintains data in an organized, easily retrievable manner.
- Maintains good personal hygiene and follows dress code
- Communicates regularly with the Regional Care Management
Specialist to discuss identified clinical reimbursement
- Ability to work flexible work hours to support business
- Ability to utilize both local and corporate resources in the
execution of job responsibilities.
- Must possess superior clinical assessment and documentation
- Must demonstrate strong interpersonal skills and ability to
work well in a team environment.
- Other duties as assigned or needed.
- Analytical reasoning
- Logical reasoning
- Problem solving
- Time management
- Organizational skills
- Research skills
- Language Skills
- Must possess excellent verbal and written communication and
- Must be a graduate of an accredited school of nursing with
current R.N. or L.V.N.
- Position may be filled by LVN, however specific job functions
denoted by "" will require an RN to Coordinate the process as
stipulated by Federal Regulations.
- Complete and pass all RIHS specific MDS/RUGs training modules
(AIS) within the first 90 days of employment and ongoing per
- Competency with standard office software applications as well
as software applications related to MDS/RAI processes.
- High initiative and ability to efficiently and effectively lead
interdisciplinary teams and coordinate and manage RAI process.
- Licensure in the state in which employment occurs.
- Minimum of two years health care experience.
- Experience with MDS completion, reimbursement, clinical
resource utilization and/or case management is highly
The physical demands described here are representative but not
necessary all inclusive, of those that must be met by an employee
to successfully perform the essential functions of this job. While
performing the duties of this job, the employee is regularly
required to effectively communicate. Reasonable accommodations may
be made to enable individuals with disabilities to perform the
Action Rarely Occasionally Frequently Lifting - 1-25 lbs X
Lifting - 25-50 lbs X Lifting - 50+ lbs X Carrying - 1-25 lbs X
Carrying - 25-50 lbs X Carrying - 50+ lbs X Pushing/Pulling - 1-25
lbs X Pushing/Pulling - 25-50 lbs X Pushing/Pulling - 50+ lbs X
Sliding/Transferring - 1-25 lbs X Sliding/Transferring - 25-50 lbs
X Sliding/Transferring - 50+ lbs X Standing X Sitting X Walking X
Speaking X Driving X Balancing/Climbing X Stooping/Kneeling X
Crouching/Crawling X Reaching X Hearing/Listening X Seeing X
Keywords: Regency Integrated Health Services, College Station , Care Management Specialist (19699), Other , Brenham, Texas
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