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Director, Case Mix - Senior Services, Mokena, IL


Requisition ID: 41118

Location: Senior Services Corporate

Location Address:
18927 Hickory Creek Place, Mokena, IL 60448-8652 United States (US)

Daily Hours: 8
Standard Hours: 40
Employment Status: Full-time
Employment Type: Regular
Shift: Day
FLSA: E

SUMMARY

The Director of Case Mix - Senior Services oversees each facility's government based reimbursement system and is accountable for improving the case mix index and necessary documentation across the division. The position assures that all facilities comply with established policies and procedures as well as state and federal regulations. Assists facility administration in managing Minimum Data Set (MDS) Coordinators and other positions related to appropriate submission of case mix information.

ESSENTIAL DUTIES AND RESPONSIBILITIES
  • Visits all Senior Services skilled and intermediate nursing facilities at regular intervals.
  • Assesses each facility departmental function relating to case mix processes for compliance with state and federal requirements.
  • Implements changes to facility programs to meet both regulatory requirements and division minimum standards in concert with facility administration.
  • Assists facility administration to identify and correct problem areas and improve services relative to case mix issues.
  • Documents findings of regular visits and report analysis to appropriate facility personnel and Chief Clinical Officer (CCO).
  • Conducts group meetings to facilitate education of facility personnel in case mix techniques.
  • Develops and maintains a working rapport with facility personnel, especially administration.
  • Assists facility administration in evaluating the performance facility MDS (Minimum Data Set) Coordinators and other supportive personnel, appropriateness of assignments and fulfillment of position description. Supports in the interviewing, performance appraisal, and disciplinary action process as needed for facility MDS Coordinators.
  • Reviews case mix index for accuracy and variation of this data and works with facility to enhance to fullest extent allowed by applicable regulations
  • Assists with the coordination of educational activities for management within the division. Assists facility with any state or federal review process of case mix related items.
  • Monitors case mix index, in conjunction with reimbursement, monthly and quarterly. Alerts division ECO and facility Administrators to significant changes.
  • Provides support for claim denials and management of associated appeals related to claim denials
  • Works collaboratively with the Director of Operations, and Directors of Quality Assurance and Performance Improvement to support adherence to state and federal regulations, RAI standards of practice
  • Educate DNS and clinical team in use of QMs
  • Responsible for analyzing QM and assisting facility staff with systems and processes for quality improvement..


  • This document represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. Other duties may be assigned.

    QUALIFICATIONS

    To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

    Education and/or Experience

    Graduate of an accredited nursing program required. Minimum three years of experience in nursing with primary focus in long-term care required. Minimum of one year management experience in long-term care, case mix reimbursement and MDS completion with reimbursement impact required. RAC-CT Certification required. One year experience managing MDS for multiple facilities preferred.

    Business Unit: PLC Senior Services
    Department Name: Quality Assurance PLC PSS
    Presence Health 
    Location: MokenaIL 60448
    Document ID: AB424-0K40  
    Job Type:  Regular

    Job Schedule: Full-time


    Posted on: 2018-01-1901/19/2018
    2018-02-18
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