Job Description

The Director of MDS is responsible for the overall successful completion of the RAI MDS process from admission to discharge in accordance to company policy and procedure, State and Federal guidelines, and all other appropriate entities.

Responsibilities and Duties

Ensure collection of resident information to allow for future assessments, including physical and mental states.

Assume a leadership role in Quality Assurance and Performance Improvement activities

Prepare and distribute clinical conference schedule

Medicare determinations on new admissions and re-admissions

Notify families and billing department regarding Medicare determinations

Prepare and track Medicare certifications and recertification’s

Ensure completion of all sections of facility MDSs.

Responsible for insurance (Managed Medicare, Managed Medicaid and Commercial) concurrent reviews

Initiate and track insurance appeals for admission denials and continued stay

Schedule UAS with Managed Medicaid providers on appropriate residents

Track coverage for insured residents from admission to discharge.

Collaboratively and cooperatively work with the MDS department, as well as interdisciplinary team

All other duties as assigned

Requirements/Qualifications:

Current NYS Licensed Registered Nurse

Clinical experience and a working knowledge of Insurance contracts

Utilization Review/Case Management/MDS experience preferred