Vivage Quality Health Partners
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Clinical Reimbursement Specialist/Restorative (RN)
at Vivage Quality Health Partners
- Requisition ID
- # of Openings
ARBOR VIEW is actively building a team who are passionate about enhancing the lives of elders in our community. The best candidates are those who have a heart for our seniors and are always looking for ways to improve their lives.
At ARBOR VIEW, your coworkers enjoy what they are doing, and management cares about staff and residents. We provide the tools and resources to help you be the best at what you do and our team as a whole is committed to your success.
We are a community designed for all stages of senior living: 118 skilled nursing beds as well as Independent and Assisted Living apartments. We serve those needing long-term care as well as short-stay rehab. Easily accessed from Wadsworth in Arvada, only minutes from Interstate 70, ARBOR VIEW is tucked away in a quiet neighborhood with the best views of Denver and the mountains. With excellent CMS quality measures, surveys, and outcomes, ARBOR VIEW is a leader in the area!
Our management company, VIVAGE SENIOR LIVING, is a nationally recognized leader and innovator in the long-term care industry. VIVAGE SENIOR LIVING is dedicated to person-centered care and we embrace the Eden Alternative™ philosophy. We bring “quality of life in aging” and “living well” to Long Term Care!
To schedule an interview, text Micaela Hughes at (720) 594-5199. You could be working as early as next week. We hold weekly orientations to fit your busy schedule.
Currently, Arbor View is seeking a Full Time CLINICAL REIMBURSEMENT/MDS COORDINATOR at their 118 bed skilled nursing community located in Arvada, CO.
The primary responsibility of the CLINICAL REIMBURSEMENT/MDS COORDINATOR is to direct, coordinate and lead MDS Systems, Medicare A, Medicare B and all other insurance providers, as well as conduct care coordination for case management following the current federal, state and local standards, guidelines and regulations that govern long term care and assisted living facilities. Incumbent is delegated the administrative authority, responsibility, and accountability necessary for carrying out your assigned duties to ensure appropriate reimbursement for services are provided within the Center.
- Thinks outside the box
- Excited to grow in longterm care
- Confident in clinical knowledge and abilities
- Works well with families
- Thrives in a fast-paced environment
PRINCIPLE DUTIES AND RESPONSIBILITIES
- Coordinates and manages the process of information and clinical integration from the Interdisciplinary Team (IDT): nursing, dietary, social services, restorative nursing, physician services and the rehabilitation team to ensure the appropriate level of skilled need and capturing of all resources.
- Perform clinical assessments and manage the data entry of residents in all care areas needed to complete regulatory/PPS and other reimbursement related MDS forms and ensure accuracy of the MDS including timely submission of the transmission process.
- Maintains current and comprehensive knowledge of MDS and Medicare/Medicaid reimbursement.
- Serves as Center resource for MDS/RUGS and Case Mix systems.
- Coordinates with the Business Office Manager required billing data such as: RUGs, case mix data, and insurance authorization required for billing accuracy.
- Assist with writing and updating Care Plans in collaboration with IDT.
- direct the restorative nursing program.
- Assess residents for need for restraints and obtain all needed consents and physician’s orders.
- Assists with coordination of the process of assessing incontinent residents for need for bladder or bowel retraining or toileting programs.
- Assist with implementation of adaptive behavior programs and other interventions consistent with the care plan for each individual resident.
- Assist with strategies and training of Center staff in terminology, language, and format that is required for capturing the highest burden of care delivered to residents and is responsible for implementation of strategies to ensure quality outcomes and fiscal responsibility for the community assessments.
- Assists with leadership within the community participating in weekly and monthly triple check, QA&A, PIC, Care Conferences, Daily Standup and PPS.
- Participate in pre-admission assessments and the decision making process regarding new admissions by calculating potential resource expenses, and estimate clinical reimbursement.
- Complete Quality Management Reports based on Quality Measures; assists in developing collaborative IDT action plans and report on process and outcomes of these action plans.
- Participate and assist in Clinical Center Programs such as: Restraint Management, Pain Management, Quality Management, Fall Management, and Medication Review.
- Assist in evaluation of the effectiveness of policies and procedures and make suggestions for revision in the interest of more effective and efficient services.
- Perform administrative duties such as evaluations, studies and audits as needed.
- Helps maintain the physical, social and psychological environment.
- Ability to maintain professional working relationships with all Center personnel, residents and families; present professional image to the consumer through dress, behavior and speech.
- Participate in new staff general orientation.
- May serve on committees such as infection control, safety, Performance Improvement, Adaptive Behavior and Culture Change. May serve as chair of some of these committees; attends department supervisor and staff meetings.
- Must follow all safety procedures; reports accident/incident hazards; assist with infection control in identifying risks; follows established infection and universal precautions policies and procedures; monitor the use and handling of equipment to ensure safe usage and avoid waste or breakage.
- Maintain confidentiality of all pertinent resident care information as well as staff information; adheres to HIPAA.
- Trains backup personnel for the Clinical Reimbursement Coordinator.
- Perform all other duties as assigned.
- Graduate from an accredited school of nursing; current RN license in the State of Colorado required.
- Must have, as a minimum, three (3) years’ experience in an administrative supervisory capacity in a hospital or nursing facility.
- Maintains strong working knowledge of the Resident Assessment Instrument (RAI) Manual as well as complete the required courses for credentialing through the American Association of Nurse Assessment Coordinators and maintain certification thereafter.
- Be able to assess residents and relate information regarding resident’s condition.
- Must have knowledge of Medicare/Medicaid and insurance reimbursement procedures, contracts, clinical resource utilization and/or case management.
- Must have basic computer operation and typing skills for efficient data input; must be able to navigate touch screen computers.
- Must have knowledge of office machines and equipment.
- Must be able to read, write, speak and understand the English language.
- Ability to make independent decisions when circumstances warrant such action.
- Must possess the ability to deal tactfully when personnel, residents, family members, visitors, government agencies/personnel and the general public.
- Knowledgeable of nursing and medical practices and procedures as well as regulations and guidelines that pertain to long term care.
- Must have patience and enthusiasm, as well as, the willingness and ability to handle difficult residents.
- Open to new ideas and be willing to incorporate them into practice.
- Experience in rehabilitation and/or geriatric nursing is desirable.
- Competence in supervision and leadership.
- Ability to stand up in front of entire staff and present/teach.
- Complete “Nonviolent Crisis Intervention” training per facility protocol.
- Must demonstrate the knowledge and skills necessary to provide care appropriate to the age-related needs of the residents served.
- Must be knowledgeable of laws, regulations, and guidelines pertaining to hospital and nursing facility administrative procedures.
- Must possess the ability to plan, organize, develop, implement, and interpret the programs, goals, objectives, policies and procedures, etc., necessary for providing quality care and maintaining a sound operation.
- Must be able to communicate policies, procedures, regulations, reports, etc., to personnel, residents, family members, visitors, and government agencies/personnel.
- Must not pose a direct threat to the health or safety of other individuals in the workplace.
Job training: how long it usually takes to competently perform this job when the incumbent has the minimum knowledge, skills, and abilities, work experience and/or education:
up to 3 months up to 6 months up to 1 year 1 -2 years 3 - 5 years 5+ years