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This position is responsible for assuring the timely completion of accurate assessmentsand interdisciplinary care plans that meet Federal and State guidelines. Included is identifying resident acuity and needs, helping to determine specific care needs and communicating needs / expectations to families and responsible parties.Principle Duties and Responsibilities1. Completes assessments, Minimum Data Set (MDS) and care plans for all residents assigned.2. Monitors completion of MDSs by other disciplines within timeframes prescribed by regulatory guidelines.3. Advises supervisor of incomplete and/or untimely assessments by disciplines other than nursing.4. Ensures accurate, timely completion of the MDS/RAPs/Triggers sheet for assigned residents.5. Initiates care plans and supporting activities that will result in best possible outcome for assigned residents.6. Generates and distributes monthly care plan calendar for the following month.7. Conducts care plan conferences for assigned residents.8. Maintains and updates all care plans and assessments for assigned residents on a quarterly basis (at minimum) and adds/deletes issues as necessary.9. Reviews all resident incidents and accidents and the 24-hour report daily to ensure that care plans for assigned residents reflect current and changing needs.10. At patient care conferences, facilitates and coordinates the activities of the disciplines of nursing, rehabilitation, dietary, activities, social services and restorative nursing. 11. Monitors and ensures completion of 7-day look-back documentation by nursing staff within prescribed MDS timeframe.12. Participates in facility management meetings as requested.13. Monitors and audits clinical record documentation on assigned residents to ensure accuracy and timeliness.14. Advises Director of Nursing Care of persistent issues related to non-compliant documentation on assigned residents.15. Promotes and participates in ongoing education, inside and outside the facility, to maintain and enhance knowledge of current / new regulations.16. Maintains current knowledge of RAI Manual and MDS assessment process.17. Attends in-service training and other educational programs as directed or authorized.18. Performs all job duties in a manner that ensures that confidential information andresident rights are protected at all times.19. Supports quality of care and operational efficiency by maintaining acceptable attendance record.20. Performs all job duties in a safe manner in accordance with established safety guidelines, protocols and expectations.21. Reports unsafe conditions when noted and immediately reports accidents to immediate supervisor or other designated on-duty manager.22. Supports and promotes facility and company standards for superior customer service by exhibiting positive, courteous, and helpful behavior when dealing with all internal and external customers.23. Complies with established standards described in facility policies and procedures, code of conduct, corporate compliance plan, employee handbook and other company documents and publications.Minimum QualificationEducation: Graduate of an accredited school of nursing in preparation for Registered Nurse or Licensed Practical Nurse licensure.Experience:One year previous experience in long term care environment. Knowledge of MDS and Care Plan process. Basic knowledge of PPS and RUGs.Other Requirements:1. Must be a Registered Nurse or a Licensed Practical Nurse licensed by the Virginia Board of Nursing.2. Demonstrates verbal and written communication skills (in the English language)sufficient to perform the principle duties and responsibilities outlined in this position description.3. Capable of performing the following minimum physical requirements:a. heavy lifting such as transferring residents from bed to wheelchair and / or lifting and carrying heavy objects;b. stooping, bending, kneeling, and reaching such as bathing a resident, wiping spills off floor, making a bed, lifting food trays from a cart, placing materials on shelves, etc.;c. frequent walking;d. pushing and pulling heavy carts such as food carts, medication carts, hand trucks, etc.;e. climbing stairs, stools, ladders.
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