Senior Insurance Risk Specialist

Sunnyspringsrehab; Gauteng; On-site; ZAR 300,000 - 600,000; Full time

Job summary

An established industry player in healthcare is seeking a dedicated MDS Coordinator to ensure the accurate completion of assessments and care management processes. In this vital role, you will collaborate with an interdisciplinary team to assess resident needs, manage MDS documentation, and ensure compliance with federal and state regulations. This full-time position offers a chance to make a significant impact on patient care while working in a supportive environment. If you are a passionate healthcare professional with a strong nursing background and a commitment to excellence, this opportunity is perfect for you.

Benefits

Healthcare

Dental

Vision

Qualifications

• Graduate of an approved RN program and licensed in the state of practice.
• Minimum of 2 years nursing experience in a Skilled Nursing Facility.

Responsibilities

• Collaborate with the Interdisciplinary Team to assess resident needs.
• Ensure timely completion of MDS assessments and care plans.
• Monitor MDS documentation for compliance with regulations.

Skills

Nursing Experience

Knowledge of Case-Mix

Federal Medicare PPS Process

Medicaid Reimbursement

Quality Indicator Process

MDS 3.0

Care Planning Process

OBRA Regulations

Education

Registered Nurse Program

Tools

Electronic Medical Records System

Job description

Join to apply for the MDS Coordinator RN or LVN role at Sunny Springs Nursing Center.

Your Job Summary: The MDS Coordinator will be responsible for timely and accurate completion of both the RAI process and care management process from admission to discharge in accordance with company policy and procedures, and Federal, State and Certification guidelines.

Principal Responsibilities:

1. Works in collaboration with the Interdisciplinary Team to assess the needs of the resident.
2. Provides interdisciplinary schedule for MDS assessments and care plan reviews as required by governing agencies.
3. Ensures that the Interdisciplinary team makes decisions for either completing or not completing additional MDS assessments based on clinical criteria as identified in the most recent version of the RAI User's Manual.
4. Assists with coordination and management of the daily stand up meeting, to include review of resident care and the setting of the assessment reference date(s).
5. Complies with federal and state regulations regarding completion and coordination of the RAI process.
6. Monitors MDS and care plan documentation for all residents; ensures documentation is present in the medical record to support MDS coding.
7. Maintains current MDS status of assigned residents according to state and federal guidelines.
8. Maintains the frequent and accurate data entry of resident information into appropriate computerized MDS programs.
9. Completes accurate coding of the MDS with information obtained via medical record review as well as observation and interview with facility staff, resident, and family members.
10. Attends interdisciplinary team meetings, quality assurance, and other meetings in order to gather information, communicate changes, and maintain and update records.
11. Assists DON or designee with identification of a significant change, physician orders, and verbal reports to assure that the MDS and care plan are reflective of those changes.
12. Prepares scheduling, notice of resident care planning conferences, and assists DON in communication of outcomes/problems to the responsible staff, resident, and/or responsible party.
13. Continually updates knowledge base related to data entry and computer technology.
14. Completes electronic submission of required documentation to the state database and other entities per company policy.
15. Corrects and ensures completion of final MDS and submits resident assessment data to the appropriate State and Federal government agencies.
16. Assigns, assists, and instructs staff in the RAI Process, PPS Medicare, Medicaid (Case Mix as required) and clinical computer system in relation to these processes.
17. Maintains confidentiality of necessary information.
18. Other duties, responsibilities, and activities may change or be assigned at any time with or without notice.

Qualifications:

1. Graduate of an approved Registered Nurse program and licensed in the state of practice, required.
2. Minimum of 2 years of nursing experience in a Skilled Nursing Facility required.
3. Excellent knowledge of Case-Mix, the Federal Medicare PPS process, and Medicaid reimbursement, as required.
4. Thorough understanding of the Quality Indicator process.
5. Knowledge of the OBRA regulations and Minimum Data Set.
6. Knowledge of the care planning process.
7. Experience with MDS 3.0, required.

Job Type: Full-Time

Benefits Offered: Healthcare, Dental, Vision

Sunny Springs Nursing Center provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

Seniority level: Entry level

Employment type: Full-time

Job function: Health Care Provider

Industries: Hospitals and Health Care