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PruittHealth Case Mix Coordinator RN/LPN HCC in North Augusta, South Carolina

Case Mix Coordinator RN/LPN HCC



Responsible for coordinating assessments for each resident including Resident Assessment Instrument (RAI), CAAs and Care Plan. This includes all admission, quarterly, annual and significant change assessments as well as any required Medicare assessment. Responsibilities include maintaining accurate and timely assessments, meeting all automation requirements as defined by the regulations, facilitating a functioning interdisciplinary team, maintaining roster and census reports and monitoring of all reports generated by this department.


1.Facilitates communication between nursing center departments and patient/family members to provide an effective assessment/care plan process.

2.Establishes open lines of communication with consultants. Have effective interviewing skills for the purpose of collecting information from patients, families, and staff members.

3.Conduct/coordinate patient (or family) interviews for assessment purposes.

4.Evaluates each patient’s condition and medical data to determine special needs, or the need to amend the admission assessment.

5.Has a comprehensive understanding of nursing resource material and understands how to

incorporate such information into care plans [i.e., nursing journal articles that relate to specific patient care topics (bowel& bladder retraining, restraint assessment & use, fall assessments, skin assessments, etc.)]

6.Establishes open lines of communication with interdisciplinary team members in order to provide a comprehensive and holistic patient care plan.

7.Maintains schedule of assessment/care plan meetings. Coordinate schedule with nursing

center staff and others (family, therapists’ etc.) to provide for appropriate participation.

8.Ensures care is provided in accordance with patient’s wishes. Coordinate the development of a care plan (preliminary and comprehensive) for each patent that identifies problems/needs, appropriate interventions, measurable goals, and assign responsibilities for delivery of care.

9.Provides that patient assessment and care plans are completed in a timeframe that is in accordance with current regulations.

10. Facilitates education to inform associates of the patient’s care plan prior to administering


11. Coordinates the review of each assessment/care plan for accuracy (including timeliness appropriate signatures and dates etc.)

12. Signs and dates each assessment to certify its completion.

13. Monitors the RAI process for accuracy according to the RAI guidelines and other accepted standards.

14. Educates the interdisciplinary team and other staff members as needed in the RAI process.

15. Conducts physical assessment of patient to provide accurate RAI process.

16. Assesses patient needs and make recommendation for skilled rehabilitative services as well as maintenance therapy services.

17. Conducts patient care conferences. May be required to direct and implement nursing service educational programs in reference to patient assessment and care.

18. May be required to meet with all shifts for the purposes of planning, coordinating, and implementing patient care.

19. Assists in compliance with Federal, State, and Local regulations in relation to scheduling, performing, and implementing patient care plans.

20. May be required to make management reports and participate in special assignments.

21. Complies with specific time limitations in terms of scheduling and planning patient care.

22. Supervises Certified Nurse Assistant.

23. Be highly involved in determining skilled level of care for Medicare residents and procuring required

Medicare-specific documentation; be responsible for physician certification of a skilled level of care throughout the Medicare stay; be involved in making eligibility determinations

24. Coordinate care with case managers for residents utilizing managed care, health maintenance

organizations (HMOs), commercial insurance, and other alternate payment models.

25. Serve as a member of the quality assessment and assurance (QAA) and/or the quality assurance and performance improvement (QAPI) committees.

26. WorkcloselywithAdmissionsdirector/SeniorNurseNavigator,Hospitalmedicalrecords,and physicianstoobtainaccurateandcompletedocumentationtosupportICD-10-CMdiagnosis

coding and surgical procedures. and physicians to obtain accurate and complete documentation to support ICD-10-CM diagnosis coding and surgical procedures.


completion of supporting documentation and MDS assessments.

28.Participate in care conferences, discharge planning, training, caregiver training, and the provision of resources as needed

29. Ensure that the residents’ rights to fair and equitable treatment, self-determination, individuality,

privacy,property,andcivilrights,includingtherighttowagecomplaints,arealwayswell- established and maintained.


  • Participates in center/agency surveys (Licensure / JCAHO) and any subsequently required reports.

  • Attends and participates in continuing educational programs to keep abreast of changes in your field as well as to maintain current license/certification, as required.

  • Attend and participate in mandatory in-services.

  • Honors patients/residents’ rights to fair and equitable treatment, self-determination, individuality, privacy, property and civil rights, including the right to wage complaints.

  • Complies with corporate compliance program.

  • Reports job-related functions/tasks that involve occupational hazards including exposure to blood and body fluids and others as necessary.

  • Follows established safety regulations, to include fire protection & prevention, smoking regulations, infection control, etc.

  • Follows established safety procedures when performing tasks and/or working with equipment.

  • Performs other related duties as necessary and as directed by supervisor.

  • Must have knowledge of Medicare and Medicaid programs and requirements. Computer literacy is necessary.



Nursing Degreefrom an accredited college or university, or is a graduate of anaccredited/approved

RN program.


A minimum of one (1) year of experience as asupervisor in a hospital, long-term care facility, or other related health carecenter.


Current, active and unrestricted RegisteredNurse (RN) licensure in state of practice.

ADDITIONAL QUALIFICATIONS: (Preferredqualifications)

Nursing service administration experience andRAI experience preferred.

Job Nursing

Primary Location South Carolina-North Augusta

Schedule Full-time

Shift 1st Shift

Job Posting Aug 25, 2020, 3:26:56 PM

Req ID: 2007219

PruittHealth is an Equal Employment Opportunity employer and does not discriminate in its personnel practices against its partners or qualified applicants for employment based on race, color, religion, sex, national origin or because he or she is an individual with a disability or a protected veteran.