MDS/Utilization Coordinator

SUMMARY: Develops and completes resident assessments,
care plans and oversees reimbursement per Medicare and

Medicaid guidelines by performing the following duties:
ESSENTIAL DUTIES AND RESPONSIBILITIES: An individual
must be able to perform each essential duty satisfactorily.
Reasonable accommodations may be made to enable
individuals with disabilities to perform the essential
functions. The requirements listed below are representative
of the knowledge, skill, and/or ability required. Other duties
as assigned.
1. Develops and completes resident assessments. This
includes but is not limited to: timely completes, transmits,
and updates assessments; implements CAAs and Triggers;
evaluates the condition, medical background, and special
assessment/activities of each resident. Coordinates
interdisciplinary meetings to review assessments.
2. Assist with plans of care. This includes but is not limited
to: ensuring timely completion of comprehensive care plan
for each resident, which is designed to meet medical,
nursing, mental, and psychosocial needs, and includes
measurable objectives to meet such needs; conducting
quarterly review or other regular assessment; and ensuring
care plan is evaluated and revised for each assessment or
status change, including discharge; coordinating timely
review of each resident’s care plan by interdisciplinary team.
3. Assists with payer coverage matters. This includes but is
not limited to: completion of pre-admission assessment;
coordinating Medicare and payer coverage; analyzing clinical
financial issues for the RAI process; communicating
concerns to appropriate staff; review clinical and therapy
documentation to ensure residents are placed in the
correct/appropriate resource utilization group (RUG) level
and assisting with coding; ensuring documentation supports
covered services per Medicare charting guidelines.
Communicates with assessment team regarding complete
and accurate assessment functions to support billing.
4. Act as Chairperson of the Interdisciplinary Care Plan
Team. Works with Interdisciplinary Care Plan Team in
developing a comprehensive resident assessment and care
plan for each resident. Provides training to staff in regard to
RAI process. Trains, evaluates, monitors and coordinates
documentation to support MDS.
5. Ensures proper documentation is maintained. This
includes but is not limited to: verification that each portion
of every assessment is signed and dated by the person
completing that portion of the MDS.
6. Performs quality assessment and assurance functions.
This includes but is not limited to: conducting ongoing
review of quality regarding resident assessment/care plans;
regularly auditing RAI process for accuracy, timeliness and
submission; assisting with audits of MDS process with
consultants and/or outside agencies; communicating
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results of internal and/or external audits to staff.
7. Coordinates any record request to validate payment;
including notification to the interdisciplinary team,
development of checklist with dates of service
documentation and mailing of the record in a timely manor.
8. Assists in developing and updating assessment and care
plan policies and procedures to reflect the philosophy of the
facility, professional standards, and legal requirements.
9. Participates with Executive Director and/or Director of
Nursing/designee in survey processes by: instructing staff
regarding conduct and disclosure, reporting, being present at
all times surveyors are on-site, directing prompt responses
to requests for information, and undertaking corrective
action, if appropriate.
10. Maintains and applies current skills and knowledge
through continuing education and in-service programs.
11. Carries out responsibilities in compliance with federal,
state, local laws and regulations, and with facility
philosophy, policies and procedures.
12. Ability to read and interpret technical journals, financial
reports, and legal documents. Ability to respond to common
inquiries or complaints from residents, regulatory agencies,
or members of the business community. Ability to present
information to management effectively. Must be able to
speak, understand and read the English language to the
extent necessary to safely and properly care for residents.
13. Excellent interpersonal skills with high level of energy
and enthusiasm. Ability to organize, document, and
implement detailed programs. Good verbal and written
communication skills.
14. This position requires standing, sitting, stooping,
pushing, pulling, lifting up to 75 pounds or more, bending,
climbing, twisting upper body, walking, running, carrying,
listening, talking, use of telephone, and exposure to medical
equipment and persons with risk of illness.

SUPERVISORY RESPONSIBILITIES:
None.

EDUCATION and/or EXPERIENCE:
Completion of registered nursing program. Experience with
MDS, resident assessments, care plans and CAAs preferred.
Meets state and federal requirements.

CERTIFICATES, LICENSES, REGISTRATIONS:
Registered nursing license per facility requirements.