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RN Consultant-Traveling
4 months ago
Clinical Reimbursement Consultant RN
Coordinates the training of center partners and audits and provides recommendation for Process Improvement for the following areas:
* The RAI Process, the Care Management Process, and the use of various supporting software applications to ensure an appropriate level of Resident care and equitable and timely reimbursement of the care provided.
* Utilization of skilled Medicare services
* Medicare RUG, Medicaid Case Mix CMI / or Skilled Level of Care management
Provides information to regional and corporate staff on the status of clinical and financial reimbursement.
* Participates in national and state professional organizations that strengthen the company's position and knowledge of the RAI process, Case Mix and clinical software programs.
* Provides information and education to center partners on the importance and use of the RAI and Care Plan, Medicare PPS, and State Case Mix and Skilled Level of Care processes and their correlation to resident care and reimbursement.
* Provides expertise, consultation and guidance to appropriate partners to ensure MDS accuracy and adherence to company policy and procedures, as well as state and federal regulations and guidelines based on information derived from audits and other available data.
* Identifies trends and areas of improvement and ensures an appropriate PI plan is completed, through analysis of financial and clinical reports.
* Maintains in-depth knowledge of the clinical software and billing system, the RAI process, and company initiated online support to help investigate and troubleshoot user-related software issues.
* Adheres to and oversees communication of privacy guidelines relative to the confidentiality of residents' protected health information.
* Frequent overnight travel may be required.
Knowledge of state and federal regulations, both clinical and financial as it relates to the RAI process and reimbursement systems.
* Current Licensed Registered Nurse or Allied Health Care Professional in state of residence. Microsoft required
* Bachelors' degree from an accredited school of Nursing or other Allied Health Care Institution
Five- (5) years health care management, MDS Assessment & care Planning experience in multi-facility, long-term care organizations preferred.
Current, active license as a Registered Nurse or Allied Health Professional in the State practicing.
Software: As an Equal Employment Opportunity employer, all qualified applicants will receive consideration without regard to race, color, religion, sex, national origin, disability, or veteran status.
