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Case Mix Director/ Registered Nurse

Company: PruittHealth
Location: Durham
Posted on: November 19, 2021

Job Description:

DescriptionPruittHealth is a COVID-19 vaccine-mandated employer. All new Partners are required to provide proof of COVID vaccination or be willing to get vaccinated within 30 days of employment. We will consider medical and/or religious exemptions on a case-by-case basis.--PruittHealth Durham3100 Erwin Rd Durham 27704$10,000 Sign On Bonus for New Employees or those former Employees that have not worked for PruittHealth in the last 12 months!JOB PURPOSE:-- --The primary purpose of this position is to provide management of resident care as related to the Resident Assessment Instrument (RAI) process, in accordance with federal and state regulations, facility policy and as directed by the Administrator. Responsible for coordination and completion of assessments for each patient including the Resident Assessment Instrument (RAI), CAAs and Care Plan. This includes all OBRA and PPS assessments in compliance with CMS requirements for completion. Responsibilities include scheduling and maintaining accurate and timely assessments, meeting all automation requirements as defined by the regulations, facilitating a functioning interdisciplinary team, maintaining roster and census reports, monitoring of all reports generated by this department, facilitating patient care plan development and review, providing oversight for department LPN staffing in compliance within the guidelines of the state nursing scope of practice, and fosters adherence to company policy and processes.--KEY RESPONSIBILITIES:1.---- Supervises Case Mix Coordinators, monitoring performance, to identify educational needs and providing education and/or coordinating education with Clinical Reimbursement Consultant.2.---- Assumes key leadership role in mentorship and education for the Case Mix Coordinator to ensure competency and retention.3.---- Facilitates communication between nursing center departments and patient/family members inorder to carry out an effective assessment to develop a comprehensive plan of care; establishing measurable goals, appropriate intervention, and assignment of responsibility in delivery of care, inaccordance with the patient---s wishes. 4.---- Establishes open lines of communication with consultants. Effectively interview for the purpose of collecting information from patients, families, and staff members.5.---- Conducts/coordinates patient (or family) interviews for assessment purposes.6. ----Evaluates each patient---s condition and medical data to determine special needs, preferences, or the need to amend the admission assessment.7.---- Maintains schedule of assessment/care plan meetings. Coordinate schedule with nursing centerstaff and others (family, therapists, etc.) to provide for appropriate participation.8.---- Provides oversight and compliance in the patient assessment and development of care plans within required timeframes and in accordance to regulations.9.---- Facilitates proactive communication with medical directors, primary care physicians (PCPs),specialists, auxiliary providers, case managers, and nurses for development of comprehensive plans of care and coordination of effective and efficient delivery of patient care across the carechain.10. Facilitates education to inform caregivers of the patient---s care plan prior to administering care.11. Coordinates the review of each assessment/care plan for accuracy (including timeliness appropriate signatures and dates etc.)12. Monitors the RAI process for accuracy according to the RAI guidelines and other accepted standards.13. Educates the interdisciplinary team and other staff members as needed in the RAI process.14. Conducts physical assessment of patient to provide accurate RAI process.15. Assesses patient needs and make recommendation for skilled rehabilitative services as well as maintenance therapy services.16. Conducts patient care conferences. May be required to direct and implement nursing serviceeducational programs in reference to patient assessment and care.17. Assists in maintaining compliance with federal, state, and local regulations.18. Be highly involved in determining skilled level of care for Medicare residents and procuring required Medicare-specific documentation; be responsible for physician certification of a skilled level of care throughout the Medicare stay; be involved in making eligibility determinations19. Coordinate-- care-- with-- case-- managers-- for-- residents-- utilizing-- managed-- care,-- health-- maintenance organizations (HMOs), commercial insurance, and other alternate payment models.20. Serve as a member of the quality assessment and assurance (QAA) and/or the quality assurance and performance improvement (QAPI) committees.21. Work-- closely-- with-- Admissions-- director/Senior-- Nurse-- Navigator,-- Hospital-- medical-- records,-- andphysicians to obtain accurate and complete documentation to support ICD-10-CM diagnosis coding and surgical procedures.22.-- Audit and improve staff education/competency as needed to ensure accurate and timely completion of supporting documentation and MDS assessments.23.-- Participate in care conferences, discharge planning, training, caregiver training, and the provision of resources as needed24. Ensure-- that-- the-- residents----- rights-- to-- fair-- and-- equitable-- treatment,-- self-determination,-- individuality,privacy, property, and civil rights, including the right to wage complaints, are always well-established and maintained.--KNOWLEDGE, SKILLS, ABILITIES:---------Has a comprehensive understanding of RAI guidelines and CMS regulation related to completion of MDS and care plan.---------Has a comprehensive understanding of nursing resource material and understands how to incorporate such information into care plans [i.e., nursing journal articles that relate to specificpatient care topics (bowel& bladder retraining, restraint assessment & use, fall assessments, skin assessments, etc.)]------- Computer literacy necessary. ------- Possess strong leadership and communication skills.------- Has ability to educate and provide oversight of other partners.------- Must have knowledge of Medicare and Medicaid programs and requirements.------- Knowledge and implementation of Human Resource policies.------- Participates in center/agency surveys (Licensure/JCAHO) and any subsequently required reports.---------Attends and participates in continuing educational programs to keep abreast of changes in your field as well as to maintain current license/certification as required.------- Attends and participate in mandatory in-services.---------Honors patients/residents--- rights to fair and equitable treatment, self-determination, individuality, privacy, property and civil rights, including the right to wage complaints.------- Complies with corporate compliance program.---------Reports job-related functions/tasks that involve occupational hazards including exposure to blood and body fluids and others as necessary.---------Follows established safety regulations, to include fire protection and prevention, smoking regulations, infection control, etc.------- Follow established safety procedures when performing tasks and/or working with equipment.#BG1to apply please email bgraves@pruitthealth.comQualificationsMINIMUM EDUCATION REQUIRED:Nursing Degree from an accredited college or university or is a graduate of an accredited/approved--RN program.----MINIMUM EXPERIENCE REQUIRED:A minimum of one (1) year of experience as a supervisor in a hospital, long-term care facility, or other related health care center. Three years of experience with RAI process.----MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:Current, active and unrestricted Registered Nurse (RN) licensure in state of practice.--ADDITIONAL QUALIFICATIONS: (Preferred qualifications)Nursing service administration experience and RAI experience preferred.Job: NursingPrimary Location: North Carolina-DurhamSchedule: Full-timeShift: 1st ShiftJob Posting: Nov 9, 2021, 2:05:14 PM

Keywords: PruittHealth, Durham , Case Mix Director/ Registered Nurse, Executive , Durham, North Carolina

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