MDS Nurse - Registered Nurse (RN)

Position Summary

The primary responsibility of the MDS Nurse is to organize, complete and evaluate resident assessment and plan of care in accordance with current applicable state, federal guidelines/ regulations and as may be directed by the Director of Nursing to ensure each resident is encouraged to attain the highest possible level of functioning.

Essential Functions, Key Duties, and Responsibilities

• Assume the authority, responsibility and accountability of coordinating the MDS, CAAS and care planning process for each resident upon admission.
• Complete triple check at beginning of month for all Medicare, Managed care and outpatient therapies.
• Observe and report changes in residents’ physical and emotional condition to the Unit Nurse
• Weekly management and update of the 672/802 as needed.
• Establish care plan dates within 7 days of completion of MDS or Quarterly review, in accordance with state and federal regulations/guidelines.
• Ensure that nursing documentation reflects the care plan being followed when administering nursing care or treatment.
• Document information obtained in the assessment process.
• Establish Assessment Reference Dates (ARD) for residents and communicate with the interdisciplinary team on the ARDs.
• Interview and observe residents and families to obtain a complete and accurate assessment before completing the MDS.
• Consult with resident’s physician in providing the resident’s care, treatment, rehabilitation, etc. as necessary.
• Participate in the community’s Quality Improvement and Quality Assurance program for the nursing service department.
• Participate in community surveys (inspections) made by authorized governmental agencies as requested.
• Report and assist in investigation of allegations of resident abuse, neglect and/or misappropriation of resident property as needed.
• Perform administrative duties such as completing medical forms, reports, evaluations, studies, charting etc., as needed.
• Create and maintain a professional atmosphere while demonstrating a positive attitude and caring demeanor under all conditions.
• Provide information for forecasting future revenue projections based on past utilization of service, case mix history, and industry trends.
• Develop and implement training on required supportive documentation for the MDS and the electronic health records.
• Promote and respect the dignity and well-being of each resident.
• Encourage resident and/or family to participate in the assessment and care planning process and to attend care plan conference via telephone and written correspondence.
• Provide administration with information regarding quality of care issues.
• Serve as a resource to other department personnel regarding resident assessment and care plan development.
• Mentor MDS Nurses so as to foster their professional growth and expand their knowledge of the assessment and care planning process.
• Respond immediately to all crises or calls for assistance as needed.
• Perform other duties as assigned.
• Comply with all policies and procedures and any updates.

Position Requirements

Education: A nursing degree from an accredited college or university

Licenses/Certifications: Current unrestricted license as a Registered Nurse (RN) in practicing state

Experience: 2+ years of MDS experience

Skills and Abilities:

• The ability to anticipate needs of residents/clients and co-workers in a pro-active fashion seeking to meet those needs even before a formal request is made.
• Excellent verbal and written communication skills.

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