Regional CaseMix Specialist

2 days ago


Maryland, United States Nexion Health Management Full time

Nexion affiliates operate 56 skilled nursing and rehabilitation as well as assisted living facilities in Louisiana, Mississippi and Texas. Each of our affiliate skilled nursing and assisted living campuses offers a home-like setting influenced by their own unique regional cultures. Our commitment to excellence is reflected in our positive clinical outcomes, resident and family member testimonials, satisfaction reports and AHCA Quality Awards. Job Summary:

The primary purpose of your job position is to coordinate delivery of services to managed care and Medicare residents in collaboration with the facility’s team member. The Regional Casemix Specialist monitors and documents the cost effectiveness of treatment provided, facilitates and coordinates the admission and discharge process, serves as the resident and family advocate and acts as a liaison to insurance and medical management

professionals.

Travel to assigned facilities required. Job Responsibilities: Educates new and current facility staff on established Medicare and Medicaid policies and procedures.

Performs routine audits of facilities for compliance with established Medicare and Medicaid policies and procedures, rules and regulations. Educates the facility staff as appropriate on Medicare and Medicaid utilization following the guidelines of Medicare and Medicaid

Is knowledgeable of MDS coding and educates facilities in correct coding and selection for MDS assessments for payment. Participates in state Medicaid audits and is knowledgeable of state specific regulations.

Supervises the Casemix Managers in each area for compliance with the above responsibilities.

Ensures that the quality and appropriateness of the resident care meets or exceeds company and industry standards and ensures that all nursing services follow state and federal legal, regulatory, accreditation and reimbursement guidelines. Promotes optimal communication among program staff members, facility staff, referral sources, physicians and residents.

Appropriately accesses the resources of the company’s regional offices for consultation and program development support. Seeks out external resources through conferences, workshops, etc. as necessary. Routinely shares personal knowledge with staff, other manager and facility personnel.

Demonstrates flexibility in adjusting to change, resident needs and customer expectations; meets company standards relating to deadline and attendance.

Job Qualifications.

Graduate of an accredited school of nursing.

Must have valid RN/LVN license in state of work (without restrictions)

Must have a minimum 5 years of MDS experience.

Computer skills in Excel, Word and websites

Extensive travel and some overnight stays required.

PCC experience is a plus.

Excellent Benefits: We offer competitive compensation and a great benefits package, including:

100% Paid Vacation/Sick,

Medical/Dental/Vision, 401k, FSA, HSA, STD/LTD, Accident and Critical Illness benefits, Life Insurance and AD&D.

#J-18808-Ljbffr



  • Hanover, Maryland, United States Allegis Global Solutions Full time

    Job DescriptionThe Sr. Communication Specialist helps employees understand company strategy, goals and objectives through the effective creation of communication collateral, management of key communication vehicles and support of the organization's communication campaigns and events. As a member of the Internal Communications team, the Sr. Communication...

  • Marketing Specialist

    2 weeks ago


    Columbia, Maryland, United States ARCO a Family of Construction Companies Full time

    ABOUT YOU:Are you creative and detail oriented? Are you passionate about marketing and are looking to make an instant impact on our business? If the answer is, "Yes" then we have an opportunity that will impress you. Who are we? We are ARCO, The Design/Build Experts.We are looking for a highly motivated Marketing Specialist to join our team in Columbia,...


  • Maryland, United States Driven Media Group Full time

    311 International Circle, Suite 120, Hunt Valley, Maryland, 21030, United States Remote Work Policy Our current remote work policy is - Mondays & Tuesdays: In Office Wednesdays, Thursdays, & Fridays: Work from Anywhere Our Hunt Valley office is always open for anyone to work from every day of the week, but you're welcome to work from anywhere on Wednesdays,...


  • Maryland Heights, United States Buildingstars Full time

    Buildingstars has 7 core values: Create Opportunities, Do It Today, HAVE FUN, Go The Extra Step, Create Win-Win, Get Better Every Day, Live The Model We are seeking an Accounts Payable Specialist who shares our values and wants to join an award winning team. Our company has been recognized as a top Inc 500 and 5000 Company and as a top Entrepreneur...


  • Maryland Heights, United States Buildingstars Full time

    Buildingstars has 7 core values:  Create Opportunities, Do It Today, HAVE FUN, Go The Extra Step, Create Win-Win, Get Better Every Day, Live The ModelWe are seeking an Accounts Payable Specialist who shares our values and wants to join an award winning team.  Our company has been recognized as a top Inc 500 and 5000 Company and as a top Entrepreneur...


  • Maryland Heights, United States Buildingstars Full time

    Buildingstars has 7 core values:  Create Opportunities, Do It Today, HAVE FUN, Go The Extra Step, Create Win-Win, Get Better Every Day, Live The ModelWe are seeking an Accounts Payable Specialist who shares our values and wants to join an award winning team.  Our company has been recognized as a top Inc 500 and 5000 Company and as a top Entrepreneur...


  • Maryland Heights, United States Grainger Full time

    About E&R: E&R Industrial, founded in 1969, is an innovative, full-line industrial supply distributor committed to providing the highest level of technical support for manufacturing operations. We provide a full suite of inventory management solutions and highly flexible programs supported by brand name quality products, competitive prices, and on-time...

  • Child Life Specialist

    4 weeks ago


    Maryland Heights, United States Ranken Jordan Pediatric Bridge Hospital Full time

    Ranken Jordan is the country's first pediatric bridge hospital. Inpatients and outpatients with complex medical conditions, injuries and illnesses come to our one-of-a-kind facility from throughout the region to get better faster and prepare for the transition back to home. A Peek Behind the Room Divider: * Founded in 1941 by Mary Ranken Jordan who...


  • Maryland, United States Mid-Atlantic Permanente Medical Group Full time

    Job Title: Hourly Dermatologist at South Baltimore Medical center Company: Mid-Atlantic Permanente Medical Group (MAPMG) Interviewing for a Dermatologist position Enjoy an integrated medical system Referral-based practices with a medical dermatology focus Supported by various specialists Opportunity for virtual dermatology visits and tele-dermatology...


  • Maryland Line, United States Bally Sports Full time

    Job Description Sinclair Digital Group is looking for a highly analytical & customer centric individual to work as a Tier 2 Digital Technical Support Specialist for AOS. The ideal candidate will have a strong technical background and a passion for delivering exceptional customer service. As a Tier 2 Digital Technical Support Specialist specializing in AOS...


  • Maryland, United States Jackson Physician Search Full time

    Join a physician-led and patient-focused health system seeking an Endocrinologist to join their collegial team of providers. The practice: Join collegial and reputable group of 6 Endocrinology providers offering quality of life practice schedule and no inpatient responsibilities Highly regarded thyroid specialists offering patients ultrasounds and thyroid...


  • Maryland, United States Jackson Physician Search Full time

    Join a physician-led and patient-focused health system seeking an Endocrinologist to join their collegial team of providers. The practice: Join collegial and reputable group of 6 Endocrinology providers offering quality of life practice schedule and no inpatient responsibilities Highly regarded thyroid specialists offering patients ultrasounds and thyroid...


  • Maryland, United States Jackson Physician Search Full time

    Join a physician-led and patient-focused health system seeking an Endocrinologist to join their collegial team of providers.The practice: Join collegial and reputable group of 6 Endocrinology providers offering quality of life practice schedule and no inpatient responsibilities Highly regarded thyroid specialists offering patients ultrasounds and thyroid...


  • Maryland, United States Jackson Physician Search Full time

    Join a physician-led and patient-focused health system seeking an Endocrinologist to join their collegial team of providers.The practice: Join collegial and reputable group of 6 Endocrinology providers offering quality of life practice schedule and no inpatient responsibilities Highly regarded thyroid specialists offering patients ultrasounds and thyroid...

  • Child Life Specialist

    4 weeks ago


    Maryland Heights, United States Ranken Jordan Pediatric Hospital Full time

    Ranken Jordan is the country's first pediatric bridge hospital. Inpatients and outpatients with complex medical conditions, injuries and illnesses come to our one-of-a-kind facility from throughout the region to get better faster and prepare for the transition back to home.A Peek Behind the Room Divider: Founded in 1941 by Mary Ranken Jordan who implored...


  • Maryland, United States USAJobs Full time

    Duties Analyze immediate and time-based public information, media relations, and community relations needs; and coordinate with internal customers and external partners to develop comprehensive communication plans. Manage exhibits program, including working with the Visual Information office to develop new exhibits, e.g., writing text, selecting photographs,...


  • Maryland, United States USAJobs Full time

    Duties Analyze immediate and time-based public information, media relations, and community relations needs; and coordinate with internal customers and external partners to develop comprehensive communication plans. Manage exhibits program, including working with the Visual Information office to develop new exhibits, e.g., writing text, selecting photographs,...

  • Child Life Specialist

    4 weeks ago


    Maryland Heights, United States Ranken Jordan Pediatric Bridge Hospital Full time

    Job DescriptionJob DescriptionRanken Jordan is the country's first pediatric bridge hospital. Inpatients and outpatients with complex medical conditions, injuries and illnesses come to our one-of-a-kind facility from throughout the region to get better faster and prepare for the transition back to home.A Peek Behind the Room Divider:Founded in 1941 by...


  • Maryland Heights, United States Chick-fil-A Supply LLC Full time

    Overview: The Sr. Talent Specialist supports the day-to-day operations of the talent team at the Chick-fil-A Supply Distribution Center (DC) in St. Louis, MO, ensuring a workforce that can meet the demands of the DC. The Sr.Talent Specialist will also contribute to the overall functioning of the reward and benefit systems to help meet broader organizational...


  • Clinton, Maryland, 20735, Prince George's County, MD, United States MEDSTAR HEALTH Full time

    General Summary of PositionJob Summary: This Diabetes Care/Education Specialist delivers comprehensive and seamless services that bridge the gap between the clinical and self-management aspects of diabetes and cardiometabolic care. You will be an integral part of the health care team that provides collaborative, comprehensive and person-centered care, and...