Compliance and Utilization Consultant for 6 SNF’s Facilities in Oklahoma and Texas. Consult and manage the Minimum Data Set Coordinators to ensure maximum clinical reimbursement and accuracy in RAI process and RUG’s migration/utilization compliance. Perform and provide overall utilization analysis in correlating negative/positive impacts of overall utilization in respect to average PPD (Per Patient Day ratios), Identifying areas and goals for improvement, staff training in Medicare regulations,… Show more Compliance and Utilization Consultant for 6 SNF’s Facilities in Oklahoma and Texas. Consult and manage the Minimum Data Set Coordinators to ensure maximum clinical reimbursement and accuracy in RAI process and RUG’s migration/utilization compliance. Perform and provide overall utilization analysis in correlating negative/positive impacts of overall utilization in respect to average PPD (Per Patient Day ratios), Identifying areas and goals for improvement, staff training in Medicare regulations, MDS process, CAA process, Care planning, and nursing documentation for skilled services. Report findings to Chief Operations Nurse and facility Administrators. Work in close collaboration with MDSC and therapy leader to optimize therapy utilization. Work in conjunction with Chief Operations Nurse and facility DON’s to correlate QM analysis and impacts on 5-star rating system. Perform Utilization Quality and Compliance Reviews-to identify implementation/utilization of policy/procedure as related to corporate compliance and the Centers for Medicaid and Medicare Services (CMS) Regulations. Monitor MDS accuracy, appropriate filed claims, ensure adjustments/modifications are completed as indicated in accordance with the Resident Assessment Instrument (RAI) Manual and CMS regulations and guidelines. Show less

MDS and care plans, QAPI

MDS and Care plans