The Regional Director of Clinical Reimbursement provides extensive training, analysis, advice and consultation to the facilities and teams within his/her area of responsibility. Ensures compliance with federal and state regulations, as well as Company policy and procedures regarding state case mix/Medicare and Managed Care payment systems. Monitors, consults, and makes effective recommendations for changes and modifications to existing facility processes, systems, policies, and practices which will assure efficient, effective and compliant state Medicaid/Medicare/Managed Care payment performance.

• Provides consultation, training and support concerning the Medicare, Managed Care and state case mix payment system for the assigned area.
• Analyzes systems and processes to determine that federal and state regulations as well as company policies and procedures are followed. Promotes compliance by performing periodic audits of MDS assessments, supporting documentation, and other relevant data.
• Recognizes, advises and promotes facility best practices and systems for dealing with state case mix/Medicare and Managed Care payment systems.
• Studies, analyze and reports period over period information and systems in order to identify trends and deviations from results in Medicare, Managed Care and State Case Mix Index and takes appropriate actions.
• Works in conjunction with teams to resolve issues effecting deviations from expected results. Recommends changes and performs follow-up to ensure that those recommendations are effectively implemented and monitored for appropriateness.
• Regularly communicates to management outside the facility on recommendations made to facility management to ensure proper implementation and follow-up.
• Serves as a liaison between state and organization related to the state case-mix process, including electronic submission and state MDS requirements related to state payment.
• Assists in the recruitment/interview process for MDS Vacancies

Please have the following requirements:
o 5-7 years prior experience in a leadership role in a multi-facility post-acute organization.

o Leadership in directing and implementing change.

o, Experience in providing staff training and consultation.

o Expertise in Minimum Data Set (MDS)/Care Planning and proficiency in Resident Assessment Instrument (RAI) process.

o Expertise in Federal, State reimbursement programs, such as Medicaid; Medicare/Reimbursement Utilization Groups (RUGS) IV; PDPM (Patient-Driven Payment Model) private insurance; Veteran`s Administration (VA) programs; bordering state contracts.

o Bachelors or more advanced degree in nursing or rehabilitation.

o Licensed Registered Nurse or Rehabilitation Therapist (PT, OT, SLP), American Association of Nurse Assessment Coordination (AANAC) certification as RAC-C Resident Assessment.

Job Type: Full-time

Please have the following requirements:
o 5-7 years prior experience in a leadership role in a multi-facility post-acute organization.

o Leadership in directing and implementing change.

o, Experience in providing staff training and consultation.

o Expertise in Minimum Data Set (MDS)/Care Planning and proficiency in Resident Assessment Instrument (RAI) process.

o Expertise in Federal, State reimbursement programs, such as Medicaid; Medicare/Reimbursement Utilization Groups (RUGS) IV; PDPM (Patient-Driven Payment Model) private insurance; Veteran`s Administration (VA) programs

o Bachelors or more advanced degree in nursing or rehabilitation.

o Licensed Registered Nurse

Job Type: Full-time

Benefits:

• 401(k)
• Dental insurance
• Flexible schedule
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Physical setting:

• Long term care
• Nursing home
• Rehabilitation center

Schedule:

• Monday to Friday

Experience:

• MDS: 3 years (Preferred)
• Clinical Documentation & Utilization Review Nurses: 3 years (Preferred)

License/Certification:

• RN (Preferred)

Job Type: Full-time

Benefits:

• 401(k)
• Dental insurance
• Flexible schedule
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Experience level:

• 5 years

Healthcare setting:

• Rehabilitation center

Patient demographics:

• Adults

Schedule:

• Monday to Friday

Work Location: In person