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Regional CaseMix Specialist

4 months ago

San Antonio, United States Texas 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.