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Click here or scroll down to respond to this candidateCandidate's Name
Jackson, NJ Street Address
EMAIL AVAILABLEPHONE NUMBER AVAILABLEWork ExperienceCASE MANAGER NJ MARKETGenesis Healthcare CentersJuly 2022 PresentResponsible For six New Jersey Centers for coordinating care between the center and the payor source. The caseload usually is between 35 to 55 patients. Some of the duties include attending each Centers Utilization Management meetings each week, to pave the way with the staff for good outcomes for the patients. Communicating with the Insurance Companies, and reviewing with them, the needs of the patients. There are numerous other assignments, NOMNCs, DENCs, the appeals process to address usually on a daily basis.MDS RNComplete Care Holiday CityAugust 2021 to July 2022140 bed facility. Responsible for resident MDS, setting the ARD properly to maximize payment. Completed all sections of the MDS including the CAA's and care plans. Record appropriate ICD-10's from hospital records, Attending physicians diagnoses, and carefully choosing the primary diagnosis. Meeting with team members for UR and Medicare meetings. Worked the long term assessments, quarterlies, annuals and SC MDS. Educated staff for proper documentation in order to be captured for reimbursement. All completed and submitted to CMS in a timely manner. MDS RN LEADGateway Care CenterAugust 2020 to August 2021180 Bed skilled nursing facility. Responsible for resident assessments upon admission through discharge. All ICD 10 codes are put in properly for maximizing revenue. Schedule the MDS assessments for all staff to be sure they can do their sections of the MDS on time. Staff education on certain sections of the MDS, for their accurate input. Monitor that the assessments are completed timely and accurately and submitted to NJ CMS in a timely manner, as to not receive any deductions/penalties in revenue. Review validation reports and make corrections as needed. MDS RN LEAD/ CASE MANAGEMENTMARQUIS REHAB AND HEALTHCAREApril 2020 to August 2021180 Bed skilled nursing facility. MDS ROLE:Responsible for resident assessments upon admission through discharge. All ICD 10 codes are put in properly for maximizing revenue. Schedule the MDS assessments for all staff to be sure they can do their sections of the MDS on time. Staff education on certain sections of the MDS, for their accurate input. Monitor that the assessments are completed timely and accurately and submitted to NJ CMS in a timely manner, as to not receive any deductions/penalties in revenue. Review validation reports and make corrections as needed. CASE MANAGEMENT ROLE: Verify prior authorization and when 1st update is needed. There were various systems used for this specific job. Learned to use the Ins Companies specific programs to send the updates. Updates consisted of the therapy notes, nurses notes, and anything pertinent to each case. It is imperative that the updates were done on the schedule the individual case worker requested, new authorization is given and the date for the next update will need to be scheduled. Issue NOMNCs in accordance to CMS for proper payments from insurance. Tight record keeping is necessary daily. Appeals process was also a component of this job. MDS RN LEADVILLAGE POINT NURSING & REHABSeptember 2019 to April 2020120 bed skilled nursing facility. Responsible for resident assessments upon admission to discharge. All ICD-10 codes found in charts and hospital records that are active, update accordingly. Schedule assessments for other departments. Staff education and care-planning. All assessments completed in a timely manner to remain in compliance with state and federal regulations. Submitted to the state following the completion date to NJ CMS. Review validations and make corrections when needed. MDS COORDINATORWHITING HEALTHCAREJune 2019 to September 2019140 bed facility. Managed the office including scheduling to submitting in a timely mannerLEAD MDS COORDINATORCLARK NURSING & REHABSeptember 2018 to June 2019140 bed Skilled Nursing Facility. Responsible for Resident assessments upon admission to discharge. All assessments completed in a timely manner to remain compliant with state and federal regulations. Submitted to the state following the completion date to NJ submission date. Successfully passed the state annual survey 3/13/19. Review validations and correct accordingly. Review QM and Casper report to inspect accuracy of MDS and possible trends.MDS COORDINATORMERIDIAN NSG & REHABOctober 2017 to June 2018Resident assessments upon admission to discharge. All assessments completed in timely manner to remain compliant with state and federal regulations. Submitted to the state following the completion date to NJ submission date. Review validations and correct accordingly. Review QM and Casper report to inspect accuracy of MDS and possible trends.ADON/MDSGenesis HealthCare - Matawan, NJFebruary 2016 to January 2017Duties included:infection control Coordinator, lead the Restorative Nursing Program, and Unit Manager of a subacute unit. During this time, MDS were my responsibility including from Admission until discharge. Participated in the weekly Utilization Review Meeting.MDS CoordinatorDONAugust 2015 to January 2016August 2015 to January 2016Managed 105 bed skilled facility. Provide to the staff, the education and products needed to give exceptional nursing care. I was the MDS coordinator during the months we were without an MDS Coordinator. As the DON monitored and updated policies and procedures according to state and federal guidelines and regulations. We had our weekly UR meetings to assure patients were progressing with their healthcare and if there is no progression set DC dates. Help the patients with the appeals if warranted. DONFebruary 2013 to July 2015Provide to the staff, the education and products needed to give exceptional nursing care. As the DON monitored and updated policies and procedures according to state and federal guidelines and regulations.ADON/MDSJanuary 2010 to January 2013As the DON monitored and updated policies and procedures according to state and federal guidelines and regulations. We had our weekly UR meetings to assure patients were progressing with their healthcare and if there is no progression set DC dates. Help the patients with the appeals if warranted.DONMDS CoordinatorGOLDEN LIVING CENTERJuly 2008 to January 2010July 2008 TO January 2010Provide to the staff, the education and products needed to give exceptional nursing care. I was the MDS coordinator during the months we were without an MDS Coordinator. As the DON monitored and updated policies and procedures according to state and federal guidelines and regulations. We had our weekly UR meetings to assure patients were progressing with their healthcare and if there is no progression set DC dates. Help the patients with the appeals if warranted. STAFF NURSEBartley Healthcare Nursing and Rehabilitation - Township of Jackson, NJ January 2006 to January 2008EducationNJ STATE PROFESSIONAL NURSEApril 2018EXCELSIOR COLLEGEJune 2008ADULT VOCATIONAL SCHOOL August1987Nursing LicensureRNExpires: July 2024State: NJExpires: July 2024State: Multi StateSkills Utilization Review Nursing MDS ICD-10 Case Management Managed CareCertificationsRAC-CTAFebruary 2022 to February 2024Advanced certification in MDS/PDPM |
