Job Description
POSITION TITLE
The RAI/MDS policy will provide the scope of the LVN MDS Nurse position for the facility.
Occupational Exposure: Category I
Department: Nursing
Reports to: MDS Coordinator
FLSA: Non- exempt
POSITION SUMMARY
To conduct, collect data that contributes to the development and completion of the resident assessment in accordance with the federal, state, and local laws, guidelines, and regulations governing the facility.
POSITION RELATIONSHIP
Collaborates with all levels of nursing personnel as well as with facility consultants, physicians and department managers and other department employees in assisting with MDS Coordinator with coordinating resident assessment instrument implementation. Provides resident assessment related education.
QUALIFICATIONS
1. PROFESSIONAL
a. Current state licensure (either a registered nurse or licensed vocational nurse)
b. Completed nursing program and has a degree from an accredited college or university.
c. Preferably a minimum of one year in resident assessment position.
d. Progressive nursing experience with demonstrated leadership and teaching abilities.
e. Demonstrated skill in management principles of planning, organizing, and directing.
2. PERSONAL
a. Must have Infection Prevention experience
b. Must have strong communication skills, both oral and written
c. Must have knowledge and awareness of the care needs of the elderly and/or chronically ill.
d. Must have knowledge and ability to teach adult learners.
e. Must have basic computer skills.
f. Must be able to organize, analyze, investigate and implement principles of infection control committee.
3. POSITION RESPONSIBILITIES
a. Conduct and collect information to assist in the development and completion of the minimum data set (MDS) in accordance with current rules, regulations, and guidelines that govern the resident assessment. Assist in the implementation of care area triggers and resident care plan.
b. Participate in facility surveys made by authorized government agencies.
c. Work with the Interdisciplinary Team(IDT) developing a comprehensive resident assessment and care plan for each resident.
d. Evaluate each resident's condition and pertinent medical data to determine any need for special assessment activities or a need to amend the admission assessment.
e. Contact and assist in scheduling participation by outside members of the care plan team, including the resident's representative and/or other interested family members.f. Participate in the planning, conducting, and scheduling of timely in-service training classes that include assessment skills or techniques needed to complete the assessment functions of the facility.
g. Ensure that all members of the assessment team are aware of the importance of completeness and accuracy in their assessment functions and that they are aware of the penalties, including civil money penalties, for false certification.
h. Assist in coordinating the development of a written plan of care (preliminary and comprehensive) for each resident that identifies the problems/needs of the resident, indicates the care to be given, goals to be accomplished, and which professional service is responsible for each element of care.
i. Ensure that the care plan includes measurable objectives and timetables to meet the resident's medical, nursing, and mental and psychosocial needs as identified in the resident's assessment.
j. Ensure that an initial resident assessment is completed according to the Resident Assessment Instrument (RAI) manual’s timeframe.
k. Ensure that a comprehensive care plan is completed within twenty-one days of the resident's admission.
l. Assist the nursing staff in encouraging the resident and his/her family to participate in the development and review of the resident's plan of care.
m. Ensure that all types of MDS assessments and care plan reviews are made on a timely basis.
n. Ensure that a complete resident assessment is conducted within fourteen days of a significant change in the resident's condition.
o. Ensure MDS assessments are transmitted timely to the appropriate agencies.
p. Attend departmental and staff meetings as directed or called.
q. Attend and participate in in-service educational classes and on-the-job training programs, etc., as scheduled or directed.
r. Perform other related assignments as required.
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