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RN Manager Clinical Reimbursement
3 months ago
Day Shift / 40hrs/wk
The Manager Clinical Reimbursement is responsible for coordinating, managing and ensuring the accuracy/capitalization of the facility’s reimbursement from its payor sources. Responsible for the coordination of the Resident Assessment Instrument (RAI) process.
Essential Duties and Responsibilities:
- Manages the facility’s RAI processes to capture accurate resident related data as well as work with all resident service department s involved in the RAI process to maximize resident’s full reimbursement potential.
- Provides/ensures accurate documentation of all services in order to maximize accurate reimbursement from all payor sources.
- Completes all performance reviews with staff along with hiring of new staff.
- Selects, trains/orients and assigned department staff. Develops standards of performance, evaluates performance, and initiates or makes staff recommendations.
- Reviews facility quality indicators, assisting as needed with identifying strengths and weaknesses of data and how it relates to facility care practices
- Manages the patient’s Medicare benefit by communication of skilled needs to the patient, family and interdisciplinary care team.
- Organize and participate in the daily Medicare meeting, utilization review and monthly end of close meetings.
- Assists with Medicare denial claims/reviews when need is identified by billing office.
- Keeps abreast of changes in the Medicare, Medicaid and managed care areans and MDS/RAI processes through journal reading, outside in-services an other sources.
- Continually upgrades and makes changes in job area to assure that departments meet the needs to the changing market, federal and/or state mandates.
- Participates in and attends all mandatory Masonicare in services and departmental staff and inservice meetings.
Education: Requires a Registered Nurse with a current Connecticut State license and a BSN or MSN graduate degree from an accredited school of nursing.
Experience: Requires at least 3-5 years experience in geriatric nursing;
Requires at least two (2) years experience with federal Medicare/Medicaid and Managed Care reimbursement systems with a thorough working knowledge of the MDS and RAI process; Requires a working knowledge of OBRA regulations as they relate to Skilled Nursing facilities; Requires strong working knowledge of statistics, data collection, analysis and presentation.
Certificates, Licenses, Registrations: Current Connecticut State RN licensure required.
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