VI HEALTHY LIVING LTD
Clinical Reimbursement Manager - RN
VI HEALTHY LIVING LTD, Hilton Head Island, South Carolina, us, 29938
Schedule: Monday - Friday 8:00 AM – 4:30 PM
Compensation:
$80,476.00 – $104,613.00 OR more
based on experience.
Vi is recognized as a Great Place to Work and one of Glassdoor's 100 Best Companies to work for. Learn from the best and accelerate your career with Vi.
What We Offer
Competitive pay
Exceptional benefits
Generous Paid Time Off – start accruing on day one
401(k) with company match
Paid maternity and paternity benefits
Award‑winning training and development
Tuition Reimbursement
Luxury work environment
Meaningful and rewarding work
TidePointe, a Vi Community, is located at 700 TidePointe Way, Hilton Head Island, SC 29928.
Responsibilities Collaborates with the Director of Nursing (DON), Clinical Reimbursement Specialist, and various disciplines to complete the Minimum Data Set (MDS), Resident Assessment Instrument (RAI), and all associated processes. With guidance and oversight from the DON, the CRM ensures completion of the assessment within the timeframe mandated by federal regulations and company policies. The CRM also manages the overall process and tracking of all Medicare/Managed Care/Medicaid case mix documents to ensure appropriate and optimal reimbursement for services provided within the Care Center. Responsibilities also include assisting with the coordination of the resident care planning processes and performing other duties as assigned. This is a safety‑sensitive position.
Principal Accountabilities / Essential Job Functions
Reviews clinical records, advance progress notes, therapy and nursing documentation to capture all care and services for optimal reimbursement.
Ensures that participants in the assessment process complete an accurate and comprehensive assessment and collaborates with the Clinical Reimbursement Specialist (where applicable) or DON to address concerns.
Tracks Medicare/Managed Care beneficiaries to determine continued and appropriate Medicare eligibility and benefit period by determining skilled level of need.
Performs concurrent and ongoing MDS review to ensure appropriate PDPM category is achieved through the capture of appropriate clinical information.
Manages coordination of ICD‑10 coding for Medicare and Managed Care billing.
Directs interdisciplinary team process to communicate opportunities to ensure capturing of all care, services, and diagnosis.
Coordinates with Rehabilitation Services Program Director, Corporate Director of Clinical Reimbursement, and Central Billing Office as needed to communicate case mix data required for accurate claim billing at month end.
Reviews additional document requests by local Medicare Administrative Contractors, insurance carriers or auditors to ensure appropriate documentation is submitted timely for review.
Encourages staff to report changes in the resident’s status and involves the DON in addressing concerns.
Confirms that residents and their families are actively involved in the information sharing and decision‑making process.
Completes resident assessment protocol documents within scope of practice.
Assists with completion of the resident care plan and the care plan conferences per requirements requested by the DON.
Provides resident and family education as needed.
Identifies and reports deviations from safe practice to the DON. Adheres to policies and guidelines of regulatory agencies (i.e., OSHA, CMS).
Manages emergency situations based on the Company’s safety and disaster policies.
Communicates and collaborates with other members of the healthcare team to resolve resident care problems and to enhance care delivery.
Participates in quality assessment/performance improvement activities and audits.
Maintains minimum data set competencies and attends annual educational programs.
Attends/participates in care center meetings, in‑services and committee meetings.
May perform CPR, use Automated External Defibrillator (AED), and render first aid in emergency situations.
Physical Requirements
Constant: Walking; ability to operate in a constant state of alertness and in a safe manner.
Frequent: Standing.
Occasional: Handling medical supplies and equipment, pushing up to 120 lbs.
Seldom: Bending, crouching, pulling, reaching up to 36 in., lifting residents (70 lbs. to 300 lbs.) with use of assistive device.
Sensory Requirements
Balance, tactile, hearing, smelling, near, midrange, color and peripheral vision.
Working Conditions
Regular on‑site physical presence is required.
Qualifications Key Competencies
Maintains a courteous and professional manner through interactions with others.
Uses a resident and customer‑focused approach to problem solving and goal setting.
Uses discretion in handling confidential information, incorporating all federal, state and local privacy and confidentiality requirements.
Possesses knowledge of regulatory compliance and continuing care retirement community operations.
Excellent knowledge of Case‑Mix, and the federal Medicare PPS process as required.
Thorough understanding of the Quality Indicator Process, and OBRA regulations.
Excellent oral and written communication skills and ability to interface and maintain effective relationships with all departments and employees in a team‑oriented environment.
Computer proficiency using Microsoft Office.
Must be sensitive to the needs of older adults and enjoy working with a senior population.
Education and Experience
Education: Graduation from a school for Registered Nurses is required.
Work Experience: Minimum 3 years of previous experience in an MDS/Clinical Reimbursement Nurse role is required.
Licensure/Certification, where required: Current state licensure as a Registered Nurse in the state where practicing is required. Current CPR and Automated External Defibrillator (AED) certifications are required. Current First Aid certification is required or must be willing and able to become First Aid certified. Food handlers certification, where required.
The application window is anticipated to close within 30 days of the date of the posting.
Pay Range: $80,476.00 – $104,613.00 /Yr.
#J-18808-Ljbffr
Compensation:
$80,476.00 – $104,613.00 OR more
based on experience.
Vi is recognized as a Great Place to Work and one of Glassdoor's 100 Best Companies to work for. Learn from the best and accelerate your career with Vi.
What We Offer
Competitive pay
Exceptional benefits
Generous Paid Time Off – start accruing on day one
401(k) with company match
Paid maternity and paternity benefits
Award‑winning training and development
Tuition Reimbursement
Luxury work environment
Meaningful and rewarding work
TidePointe, a Vi Community, is located at 700 TidePointe Way, Hilton Head Island, SC 29928.
Responsibilities Collaborates with the Director of Nursing (DON), Clinical Reimbursement Specialist, and various disciplines to complete the Minimum Data Set (MDS), Resident Assessment Instrument (RAI), and all associated processes. With guidance and oversight from the DON, the CRM ensures completion of the assessment within the timeframe mandated by federal regulations and company policies. The CRM also manages the overall process and tracking of all Medicare/Managed Care/Medicaid case mix documents to ensure appropriate and optimal reimbursement for services provided within the Care Center. Responsibilities also include assisting with the coordination of the resident care planning processes and performing other duties as assigned. This is a safety‑sensitive position.
Principal Accountabilities / Essential Job Functions
Reviews clinical records, advance progress notes, therapy and nursing documentation to capture all care and services for optimal reimbursement.
Ensures that participants in the assessment process complete an accurate and comprehensive assessment and collaborates with the Clinical Reimbursement Specialist (where applicable) or DON to address concerns.
Tracks Medicare/Managed Care beneficiaries to determine continued and appropriate Medicare eligibility and benefit period by determining skilled level of need.
Performs concurrent and ongoing MDS review to ensure appropriate PDPM category is achieved through the capture of appropriate clinical information.
Manages coordination of ICD‑10 coding for Medicare and Managed Care billing.
Directs interdisciplinary team process to communicate opportunities to ensure capturing of all care, services, and diagnosis.
Coordinates with Rehabilitation Services Program Director, Corporate Director of Clinical Reimbursement, and Central Billing Office as needed to communicate case mix data required for accurate claim billing at month end.
Reviews additional document requests by local Medicare Administrative Contractors, insurance carriers or auditors to ensure appropriate documentation is submitted timely for review.
Encourages staff to report changes in the resident’s status and involves the DON in addressing concerns.
Confirms that residents and their families are actively involved in the information sharing and decision‑making process.
Completes resident assessment protocol documents within scope of practice.
Assists with completion of the resident care plan and the care plan conferences per requirements requested by the DON.
Provides resident and family education as needed.
Identifies and reports deviations from safe practice to the DON. Adheres to policies and guidelines of regulatory agencies (i.e., OSHA, CMS).
Manages emergency situations based on the Company’s safety and disaster policies.
Communicates and collaborates with other members of the healthcare team to resolve resident care problems and to enhance care delivery.
Participates in quality assessment/performance improvement activities and audits.
Maintains minimum data set competencies and attends annual educational programs.
Attends/participates in care center meetings, in‑services and committee meetings.
May perform CPR, use Automated External Defibrillator (AED), and render first aid in emergency situations.
Physical Requirements
Constant: Walking; ability to operate in a constant state of alertness and in a safe manner.
Frequent: Standing.
Occasional: Handling medical supplies and equipment, pushing up to 120 lbs.
Seldom: Bending, crouching, pulling, reaching up to 36 in., lifting residents (70 lbs. to 300 lbs.) with use of assistive device.
Sensory Requirements
Balance, tactile, hearing, smelling, near, midrange, color and peripheral vision.
Working Conditions
Regular on‑site physical presence is required.
Qualifications Key Competencies
Maintains a courteous and professional manner through interactions with others.
Uses a resident and customer‑focused approach to problem solving and goal setting.
Uses discretion in handling confidential information, incorporating all federal, state and local privacy and confidentiality requirements.
Possesses knowledge of regulatory compliance and continuing care retirement community operations.
Excellent knowledge of Case‑Mix, and the federal Medicare PPS process as required.
Thorough understanding of the Quality Indicator Process, and OBRA regulations.
Excellent oral and written communication skills and ability to interface and maintain effective relationships with all departments and employees in a team‑oriented environment.
Computer proficiency using Microsoft Office.
Must be sensitive to the needs of older adults and enjoy working with a senior population.
Education and Experience
Education: Graduation from a school for Registered Nurses is required.
Work Experience: Minimum 3 years of previous experience in an MDS/Clinical Reimbursement Nurse role is required.
Licensure/Certification, where required: Current state licensure as a Registered Nurse in the state where practicing is required. Current CPR and Automated External Defibrillator (AED) certifications are required. Current First Aid certification is required or must be willing and able to become First Aid certified. Food handlers certification, where required.
The application window is anticipated to close within 30 days of the date of the posting.
Pay Range: $80,476.00 – $104,613.00 /Yr.
#J-18808-Ljbffr