Mds Coordinator Utilization Review
Resume:
Trish Milos
Jackson, NJ *****
**********@*****.***
Work Experience
CASE MANAGER NJ MARKET
Genesis Healthcare Centers
July 2022 – Present
Responsible 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, NOMNC’s, DENC’s, the appeals process to address usually on a daily basis.
MDS RN
Complete Care Holiday City
August 2021 to July 2022
140 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 LEAD
Gateway Care Center
August 2020 to August 2021
180 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 MANAGEMENT
MARQUIS REHAB AND HEALTHCARE
April 2020 to August 2021
180 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 LEAD
VILLAGE POINT NURSING & REHAB
September 2019 to April 2020
120 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 COORDINATOR
WHITING HEALTHCARE
June 2019 to September 2019
140 bed facility. Managed the office including scheduling to submitting in a timely manner
LEAD MDS COORDINATOR
CLARK NURSING & REHAB
September 2018 to June 2019
140 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 COORDINATOR
MERIDIAN NSG & REHAB
October 2017 to June 2018
Resident 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/MDS
Genesis HealthCare - Matawan, NJ
February 2016 to January 2017
Duties 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 Coordinator
DON
August 2015 to January 2016
August 2015 to January 2016
Managed 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. DON
February 2013 to July 2015
Provide 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/MDS
January 2010 to January 2013
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.
DON
MDS Coordinator
GOLDEN LIVING CENTER
July 2008 to January 2010
July 2008 TO January 2010
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. STAFF NURSE
Bartley Healthcare Nursing and Rehabilitation - Township of Jackson, NJ January 2006 to January 2008
Education
NJ STATE PROFESSIONAL NURSE
April 2018
EXCELSIOR COLLEGE
June 2008
ADULT VOCATIONAL SCHOOL August
1987
Nursing Licensure
RN
Expires: July 2024
State: NJ
Expires: July 2024
State: Multi State
Skills
• Utilization Review
• Nursing
• MDS
• ICD-10
• Case Management
• Managed Care
Certifications
RAC-CTA
February 2022 to February 2024
Advanced certification in MDS/PDPM
Contact this candidate