Corporate Director of Clinical Reimbursement

Landmark Management Solutions is a New England based owner, operator and management services provider dedicated to the Long-term & Rehabilitative Care Industry. With particular concentration and specialized resource capacity in the skilled nursing sector, Landmark’s unique experience qualifications and business history has contributed to its valued reputation for achieving results and in leading the way to better outcomes.

We are looking for an experienced Corporate Director of Clinical Reimbursement to join our team. In this position, you will:

• Be responsible for assessment, oversight, education and implementation of programs and services relating to PDPM MDS, OBRA MDS, Medicaid CMI Management & Oversight, and Managed Care Case Management: and all MDS functions and processes.
• Maintain knowledge of and oversee the company’s policies, procedures, programs, and practices related to Medicare PDPM MDS, Medicaid OBRA MDS, Medicaid CMI and Case Management completion compliance.
• Be responsible for the clinical aspects of financial optimization as it relates to assigned facility’s MDS (Minimum Data Set) completion, COT requirements, PPS (Prospective Payment System) processes, and Medicaid Case Mix (CMI) processes, Managed Care contracting and Case Management, Medicare Denial of Payment activities and CMI Medicaid payments.
• Be the company liaison and be responsible for Medicare and Medicaid Audits and ADR’s coordination and resolutions, while working with the center team personnel.
• Manage and maintain case management oversight function for managed care, commercial insurers and developing ACO platforms
• Be the company liaison with MDS software management organization (Point Right) and MDS consulting organizations (Zimmets).
• Be the company liaison with Federal and State Reporting platforms, like Five Star, MCR VBP, MCR QRP, and all specs of the center Quality Measures education and outcome management.
  
  
  

Qualifications Include:

• Graduate from an approved nursing education program. Currently licensed as a Registered Professional Nurse (RN) in the state of practice. LPN and non-nursing candidates will not be considered.
• RAC-CT Credential
• Extensive experience in Medicare MDS, Medicaid MDS, CMI and PDPM management in the long-term industry.
• Must be knowledgeable of MDS, Medicare and Medicaid regulations, and all aspects of clinical reimbursement governing long-term care.
• Previous training experience at a regional, corporate level and national education level.
• Extremely strong computer skills -Proficient with all Windows applications including Excel.
  
  
  

The Corporate Director of Clinical Reimbursement’s primary role is to provide ongoing support, educational and technical advancement advice for center based MDS PPS and MDS OBRA Coordinator coordinators. The direct results will be to ensure that center-based Medicare and Medicaid CMI optimization and efficiency occur while also ensuring that managed care contracts and one-time capitated Managed Care/ACO payment arrangements are optimized as the changing healthcare reimbursement environment continues to unfold. In doing so, you will support five Massachusetts based facilities located in Cambridge, Dorchester, Hyannis, Framingham, and Worcester. This position provides both work from home office and travel to the various facilities.

At Landmark, we offer the following incentives:

• Competitive compensation
• A comprehensive, outstanding benefit package including generous vacation, holiday pay, health, dental, and vision insurance with employer contribution and healthcare reimbursement.
• Retirement Planning with 401(k) matching.
• 100% paid by employer life, accidental death and dismemberment, and long-term disability insurance.