Job Description

Job Description: MDS Nurse Position Summary: The MDS Nurse is accountable for coordinating and overseeing the full collaborative, interdisciplinary assessment and care planning process from Admission to Discharge. This process includes comprehensive resident assessments; care coordination and planning; resident advocacy and teaching; facilitation of open communication among care team members, the elder, and family; collection and transmission of data for the purposes of quality improvement; adherence to the Minimum Data Set (MDS), and Resident Assessment Instrument (RAI) as per Federal and State regulations. Primary Duties & Responsibilities: Conduct careful and thorough physical and psychological nursing assessments on each resident identified as at risk during the completion of the comprehensive assessment & Care Area Assessment process; sign & certify for completion and accuracy of assessments according to policy and procedures set-forth by the facility. Responsible for the completion of any additional assessments required per Federal guidelines including, but not limited to (the PAE, PASSR, Significant Change Assessments); determines the ARD. Create care plans based on comprehensive resident assessments using measurable goals and objectives. This information will be obtained through elder and family interviews, visual physical assessments, direct observations, and inputs from the Interdisciplinary Care Team; ensuring individualized interventions based on risk factors and impairments in functional capacity reflect the elder’s current status; including monitoring effectiveness of the interventions. In association with the Social Services Department, schedule and lead the Care Plan Meeting. Responsible for effectively communicating & collaborating with staff, and Interdisciplinary Care Team; gather and analyze information to formulate an individual plan of care; ensure information obtained for the care plan is reflected in the nursing progress notes. Accurately record data and electronically transmit the MDS to CMS within the designated time frames in order to receive reimbursement and quality measures. Attend applicable facility meetings as scheduled. Ensure any problems, goals, and interventions are identified on the care plan; work with the IDT on quality improvement. Attend seminars/webinars, or any other training to increase knowledge and competence; stay informed of changing Federal and State regulations. Perform as floor nurse on an as needed basis to carry out nursing procedures, and administer treatments/medications per the physician’s plan of care. Other duties as assigned by the Director of Nursing, and Administration. Qualifications: A valid TN or Multi-State LPN, RN, RN-BSN license, with clinical experience in a healthcare setting. Job Knowledge, Skills and/or Abilities: Knowledge of current State, Federal, and CMS regulations In-depth working knowledge of the RAI user manual Possess both written & oral communication skills Able to relate professionally, positively, and cooperatively with staff, elders, and family members. Able to plan and coordinate performance of duties to meet requirements of care planning. Must have either experience through on-the-job training, or a MDS certification. Proficiency in MDS 3.0, ICD-10 coding and Care Payment Level categories (Case Mix) Special Demands: Must be in good physical and mental health. Requires ability to walk short or long distances for extended periods of time. Job’s normal environment: Works in a clean, well-lighted, and well-ventilated main building, including nine separate outbuildings. The work environment may involve physical risks or hazardous conditions, and exposure to communicable diseases requiring universal standard precautions.

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