Presentation Rehabilitation is in need of an experienced RN, Clinical Reimbursement Regional Director/MDS Case Manager.
Very competitive rate depending on experience.
Apply or text "PRESMDS" to 774-786-8792 for immediate consideration.
Presentation Rehabilitation & Skilled Care Center is a not for profit skilled nursing home facility. We are newly remodeled, Joint Commission accredited, and highly rated by DPH/CMS. Presentation is a 122-bed SNF, specializing in sub-acute, short term and long term care.
The Regional Clinical Reimbursement Specialist is directly responsible for the management of the MDS RAI process, Medicaid Case Mix, Medicare/PDPM and Managed Care systems across 5 centers to ensure appropriate reimbursement in accordance with all applicable laws and regulations.
Responsibilities:
Ø Oversee MDS coding accuracy across all disciplines, including the care plan process
Ø Reviews clinical documentation, skilled processes and accuracy of skilled reimbursement to support accurate claims and billing, and adherence to company’s Triple Check Process.
Ø Monitor MDS Completion and Transmission of MDS assessments and conduct clinical reviews to support MDS accuracy and pertinent PDPM/Case Mix qualifier accuracy
Ø ICD-10 Coding for accuracy and reimbursement
Ø Serves as a resource to facility teams in Medicare, Medicaid, ACO and Managed Care/Commercial plans to capture clinical complexity that supports favorable clinical and financial outcomes
Ø Act as an educator, trainer, auditor and advisor to the clinical reimbursement teams and pertinent facility staff with up to date regulatory and compliance standards of practice.
Ø Will support centers’ Clinical Reimbursement departments in an advisory role in personnel management including approval of time off, coverage plans, performance appraisals, competencies, and hiring/terminating of staff.
Ø Engages facility management team in problem solving to identify improvement opportunities and achieve solutions
Ø Facilitate effective, well organized utilization meetings, establish productive objectives and follow through with action plans
Ø Works collaboratively with Regional Clinical, Operations and Quality Assurance team to provide regional and facility interdisciplinary teams with education and support for the development of systems to address and manage Quality Measures, CMS Five Star Rating, VBP and QRP data. Manages, coordinates and collaborates review with interdisciplinary team members on the above data elements.
Ø Directly responsible for compliance of clinical reimbursement, including timely completion of internal/external audits and reviews.
Ø Supports centers through DPH survey, plans of correction, and Case Mix Audits.
Qualifications
Ø Current license as a Registered Nurse issued by the State Board of Nursing. (Will consider LPN with extensive RAI and regional level experience)
Ø Minimum 5 + years’ experience with the RAI process
Ø Prior multi facility experience preferred
Ø Possess strong oral and written communication skills. Organizational and analytical skills required.
Ø Ability to function effectively in multi-faceted systems and to interact effectively with all levels of staff and customers.
Ø Self-directed, able to take initiative and follow through to achieve desired outcomes.
Ø Strong attention to detail and accuracy with ability to multi task and prioritize during times of high volume.
Ø Must be flexible and able to work effectively with others
Ø Point Click Care, Net Health, Microsoft Word, Excel and Power Point a plus!
Job Type: Full-time
Joining our team offers the opportunity to lead a dedicated healthcare team, make a difference in patient care, and contribute to the success of our organization.
Job Type: Full-time
Pay: $85,000.00 - $110,000.00 per year
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Tuition reimbursement
- Vision insurance
Schedule:
Work setting:
- Assisted living facility
- Nursing home
- Rehabilitation center
Ability to Relocate:
- Massachusetts: Relocate before starting work (Required)
Work Location: On the road