R&E Nurse- Med Care Services (740435) - TulaRay

QUALIFICATIONS:

• Licensed Registered Nurse
• Knowledge of Microsoft Office Suite programs including outlook, word and excel
• Long-term care experience is preferred
• Minimum Data Set (MDS) experience preferred
• OBRA experience and knowledge preferred
• Effective verbal and written communication

MAJOR POSITION DUTIES AND RESPONSIBILITIES:

• Evaluate and review medical, physical, rehabilitative, restorative, and other care being provided to determine appropriateness.
• Review, understand and relate pertinent Departmental, State and Federal policies, licensure requirements, and regulations to ensure compliance by Medical Assistance (MA)/OLTL providers.
• Participate in the development of new and/or revision to existing medical assistance policies and regulations.
• Coordinate and interact with other Agencies and Departments to ensure appropriate services for individuals using long term living services.
• Perform monitoring reviews in all Long-Term Living settings to determine that the provision and adequacy of medical, social, physical, rehabilitative, and restorative care services are being provided in accordance to all regulations and licensure criteria.
• Review Minimum Data Set (MDS) submitted to the MDS database for accuracy and documentation support in the clinical records.
• Review PA Pre-Admission Screening Resident Review (PA-PASRR-ID) process to assure nursing facilities (NF) compliance with the Omnibus Budget Reconciliation Act (OBRA).
• Perform evaluations of identified targeted individuals residing in long term care facilities including submission of packet with recommendations to the appropriate Program Office (OMHSAS, ODP, ORC, or DMVA) for review.
• Monitor appropriateness of NF admissions and determine need for continued stay by reviewing clinical records, evaluate discharge plans and interview staff and residents.
• Perform financial reviews to identify recoveries to ensure adjustments are made for any inappropriate payments or billings in accordance with established regulations and guidelines.
• Assist the Financial Representative with processing recoveries through reviewing supportive documentation and/or remittance advices submitted by the NF.
• Coordinate on-site NF reviews, including pre-review activities, entrance and exit conferences appropriate paperwork during the review and all post review activities.
• Perform follow up reviews to ensure compliance with corrective action plans as submitted by the nursing facility.
• Perform any specialized reviews and projects with MA/OLTL providers as necessary.
• Monitor individuals who receive services in the Ventilator and Durable Medical Equipment Programs to ensure that they continue to receive services and that they are using their DME as approved by the Program.
• Perform assessments for individuals in the Home and Community Based Waiver Programs (HCBS) as requested.
• Assist with other PDA and OLTL projects as an assessor or monitor of services, as necessary.
• Act as a resource for exchange of information through verbal and written communication with NF to enhance NF's awareness of applicable Federal and State regulations.
• Provide technical assistance to NF staff as needed to achieve NF compliance with applicable Federal, State and Department requirements pertaining to the Field Operations review process (MDS, OBRA, Financial).
• Process Facility Alert/Act 28 forms to notify appropriate agencies of any issues identified during reviews.
• Participate in formal training programs.
• Acquire knowledge and be proficient in the use of office equipment including laptop computer and relevant software.
• Perform other related job duties.

About Us:

TulaRay partners with clients to create staffing solutions that meet unique organizational needs. Our services are designed to reduce administrative burdens, protect your brand, and improve assignment time-to-fill. We believe that mutually successful client relationships are built on lasting quality and exceptional customer service. We pride ourselves on our uncompromising commitment to high-quality emergency management & healthcare personnel, while ensuring that our clients are taken care of with personalized attention. TulaRay manages total compliance and respectfully supports hundreds of professionals and patient-centered programs.

TulaRay is proud to be an affirmative action employer and is committed to providing equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status. If you have a disability or special need that requires accommodation, please let us know by visiting our website at tularay.com