iHire
Laurel Health Care Company has partnered with iHire to reach top talent for their opening below. Check it out and apply via iHireHealthcareAdministration today! The Director of Clinical Reimbursement will organize, direct, and provide training in the RAI Process and clinical documentation. This position is responsible for staying current on state‑specific quality incentives and reimbursement related to clinical documentation. This role provides strategic direction and analysis to the clinical teams for quality improvement, education, guidance, and development of CRSs (Clinical Resource Specialists). The position uses various supporting software applications and collaborates with corporate, regional, and facility interdisciplinary teams. The Director will travel to our skilled nursing facilities in Ohio, Indiana, Virginia, and North Carolina.
Benefits
Competitive pay
Medical, dental, and vision insurance
401K with matching funds
Life Insurance
Employee discounts
Tuition Reimbursement
Student Loan Reimbursement
Responsibilities
Assist with development of systems/processes in collaboration with VPCO and VPO to ensure regional and facility staff can perform efficiently.
Provide information and education on the importance and use of the RAI/PPS/VA processes and their correlation to resident care and reimbursement.
Provide instruction on how to read, interpret and use the information contained in various state and company generated reports, such as State Missing Assessment Report, Quality Indicators/Quality Measures, State Validation, Simple LTC Reports, etc.
Based on information derived from audits and other available data, the Director provides expertise, consultation, and guidance to appropriate employees to ensure MDS (Minimum Data Set) accuracy and adherence to company policy and procedures as well as state and federal regulations and guidelines.
Through analysis of financial and clinical reports, identify trends and areas of improvement and ensure an appropriate action plan is completed monthly.
Maintain in-depth knowledge of the clinical billing system and the MDS process to help investigate/troubleshoot user‑related software issues.
Oversee and coordinate the process for a thorough and timely orientation for new MDS Coordinators.
Ensure current, new, and revised RAI/PPS information is distributed to appropriate employees promptly.
Participate in the Quality Review process.
Schedule announced and unannounced visits to the facilities.
Serve as a member of the CQAMC meeting as required.
Serve as a member of the policy and procedure committee.
Oversee the restorative program policies and procedures.
Assist in identifying changes necessary regarding current policies and procedures and established facility policies and procedures and communicate recommendations to the VPCO.
Requirements
Active RN (Registered Nurse) license in state of residence or state(s) of practice; bachelor’s degree in nursing (BSN) is preferred.
NAC Certification.
Must have, as a minimum, 5+ years experience with RAI process and PPS at the regional level or above and regulations knowledge.
Multi‑facility experience preferred with Ohio, NC, VA and IN state‑specific experience.
Demonstrate and understand value‑based payment and case‑mix reimbursement methodology.
Ability to travel up to 50%.
Ciena Healthcare is a national organization of skilled nursing, subacute, rehabilitative, and assisted living providers dedicated to achieving the highest standards of care in five states including Michigan, Ohio, Virginia, North Carolina, and Indiana. We serve our residents with compassion, concern, and excellence, believing that every one of them is a unique person who deserves our best each day that we care for them. Join us if you have a passion for improving the lives of those around you and working with others who feel the same way.
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Benefits
Competitive pay
Medical, dental, and vision insurance
401K with matching funds
Life Insurance
Employee discounts
Tuition Reimbursement
Student Loan Reimbursement
Responsibilities
Assist with development of systems/processes in collaboration with VPCO and VPO to ensure regional and facility staff can perform efficiently.
Provide information and education on the importance and use of the RAI/PPS/VA processes and their correlation to resident care and reimbursement.
Provide instruction on how to read, interpret and use the information contained in various state and company generated reports, such as State Missing Assessment Report, Quality Indicators/Quality Measures, State Validation, Simple LTC Reports, etc.
Based on information derived from audits and other available data, the Director provides expertise, consultation, and guidance to appropriate employees to ensure MDS (Minimum Data Set) accuracy and adherence to company policy and procedures as well as state and federal regulations and guidelines.
Through analysis of financial and clinical reports, identify trends and areas of improvement and ensure an appropriate action plan is completed monthly.
Maintain in-depth knowledge of the clinical billing system and the MDS process to help investigate/troubleshoot user‑related software issues.
Oversee and coordinate the process for a thorough and timely orientation for new MDS Coordinators.
Ensure current, new, and revised RAI/PPS information is distributed to appropriate employees promptly.
Participate in the Quality Review process.
Schedule announced and unannounced visits to the facilities.
Serve as a member of the CQAMC meeting as required.
Serve as a member of the policy and procedure committee.
Oversee the restorative program policies and procedures.
Assist in identifying changes necessary regarding current policies and procedures and established facility policies and procedures and communicate recommendations to the VPCO.
Requirements
Active RN (Registered Nurse) license in state of residence or state(s) of practice; bachelor’s degree in nursing (BSN) is preferred.
NAC Certification.
Must have, as a minimum, 5+ years experience with RAI process and PPS at the regional level or above and regulations knowledge.
Multi‑facility experience preferred with Ohio, NC, VA and IN state‑specific experience.
Demonstrate and understand value‑based payment and case‑mix reimbursement methodology.
Ability to travel up to 50%.
Ciena Healthcare is a national organization of skilled nursing, subacute, rehabilitative, and assisted living providers dedicated to achieving the highest standards of care in five states including Michigan, Ohio, Virginia, North Carolina, and Indiana. We serve our residents with compassion, concern, and excellence, believing that every one of them is a unique person who deserves our best each day that we care for them. Join us if you have a passion for improving the lives of those around you and working with others who feel the same way.
#J-18808-Ljbffr