Mobile Logo

PruittHealth Case Mix Director RN HCC in Rock Hill, South Carolina

Case Mix Director RN HCC



Responsible for coordination and completion of assessments for each patient including the Resident Assessment Instrument (RAI), CAAs and Care Plan. This includes all OBRA and PPS assessments in compliance with CMS requirements for completion. Responsibilities include scheduling and maintaining accurate and timely assessments, meeting all automation requirements as defined by the regulations, facilitating a functioning interdisciplinary team, accurate reporting of Resource Utilization Groups (RUGs) to all departments, maintaining roster and census reports, monitoring of all reports generated by this department, facilitating patient care plan development and review, providing oversight for department LPN staffing in compliance within the guidelines of the state nursing scope of practice, and fosters adherence to company policy and processes.


  1. Supervises Case Mix Coordinators, monitoring performance, to identify educational needs and providing education and/or coordinating education with Clinical Reimbursement Consultant.

  2. Assumes key leadership role in mentorship and education for the Case Mix Coordinator to ensure competency and retention.

  3. Facilitates communication between nursing center departments and patient/family members in order to carry out an effective assessment to develop a comprehensive plan of care; establishing measurable goals, appropriate intervention, and assignment of responsibility in delivery of care, in accordance with the patient’s wishes.

  4. Establishes open lines of communication with consultants. Effectively interview for the purpose of collecting information from patients, families, and staff members.

  5. Conducts/coordinates patient (or family) interviews for assessment purposes.

  6. Evaluates each patient’s condition and medical data to determine special needs, or the need to amend the admission assessment.

  7. Maintains schedule of assessment/care plan meetings. Coordinate schedule with nursing center staff and others (family, therapists, etc.) to provide for appropriate participation.

  8. Provides oversight and compliance in the patient assessment and development of care plans within required timeframes and in accordance to regulations.

  9. Facilitates proactive communication with medical directors, primary care physicians (PCPs), specialists, auxiliary providers, case managers, and nurses for development of comprehensive plans of care and coordination of effective and efficient delivery of patient care across the care chain.

  10. Facilitates education to inform caregivers of the patient’s care plan prior to administering care.

  11. Coordinates the review of each assessment/care plan for accuracy (including timeliness appropriate signatures and dates etc.)

  12. Monitors the RAI process for accuracy according to the RAI guidelines and other accepted standards.

  13. Educates the interdisciplinary team and other staff members as needed in the RAI process.

  14. Conducts physical assessment of patient to provide accurate RAI process.

  15. Assesses patient needs and make recommendation for skilled rehabilitative services as well as maintenance therapy services.

  16. Conducts patient care conferences. May be required to direct and implement nursing service educational programs in reference to patient assessment and care.

  17. Assists in maintaining compliance with federal, state, and local regulations.



Nursing Degree from an accredited college or university, or is a graduate of an accredited/approved RN program.


A minimum of one (1) year of experience as a supervisor in a hospital, long-term care facility, or other related health care center. Three years of experience with RAI process.


Current, active and unrestricted Registered Nurse (RN) licensure in state of practice.

ADDITIONAL QUALIFICATIONS: (Preferred qualifications)

Nursing service administration experience and RAI experience preferred

Job Nursing

Primary Location South Carolina-Rock Hill

Schedule Full-time

Shift 1st Shift

Job Posting Dec 6, 2018, 3:49:15 PM

Req ID: 1808143

PruittHealth is an Equal Employment Opportunity employer and does not discriminate in its personnel practices against its partners or qualified applicants for employment based on race, color, religion, sex, national origin or because he or she is an individual with a disability or a protected veteran.

An Equal Opportunity Employer/Program. Auxiliary aids and
services available upon request to individuals with disabilities.

Legal | Privacy Statement | Disclaimer