Regional Healthcare CaseMix Coordinator

2 weeks ago

Houston, Texas, United States Nexion Health Full time

Regional CaseMix Specialist

Nexion Health Management

Houston, TX

This role is designed for a corporate regional setting, focusing on healthcare services.

Nexion affiliates manage a network of skilled nursing and rehabilitation facilities, as well as assisted living establishments across multiple states. Each facility provides a nurturing environment shaped by its unique regional characteristics. Our dedication to quality is evident in our outstanding clinical results, positive feedback from residents and families, satisfaction surveys, and recognition through industry awards.

Position Overview:

The primary objective of this position is to oversee the provision of services to managed care and Medicare residents in partnership with the facility's team. The Regional CaseMix Specialist is responsible for monitoring and documenting the cost efficiency of treatments, facilitating the admission and discharge processes, advocating for residents and families, and serving as a liaison with insurance and medical management professionals. Travel to designated facilities is a requirement.

Key Responsibilities:

Provide training to new and existing facility staff on Medicare and Medicaid policies and procedures. Conduct regular audits of facilities to ensure compliance with Medicare and Medicaid regulations. Educate facility staff on appropriate Medicare and Medicaid utilization in accordance with established guidelines. Possess knowledge of MDS coding and instruct facilities on accurate coding and selection for MDS assessments related to reimbursement. Participate in state Medicaid audits and maintain awareness of state-specific regulations. Supervise CaseMix Managers to ensure adherence to compliance responsibilities. Ensure that the quality and appropriateness of resident care meet or exceed company and industry standards, while ensuring compliance with all legal, regulatory, accreditation, and reimbursement guidelines. Foster effective communication among program staff, facility personnel, referral sources, physicians, and residents. Utilize resources from the company's regional offices for consultation and program development support, while actively seeking external resources through conferences and workshops as needed. Share knowledge with staff and facility personnel. Exhibit adaptability in response to changes, resident needs, and customer expectations; adhere to company standards regarding deadlines and attendance.

Qualifications:

Graduate from an accredited nursing program. Valid RN/LVN license in the state of employment (without restrictions). Minimum of 5 years of experience with MDS. Proficient in Excel, Word, and online platforms. Willingness to travel extensively, including some overnight stays. Experience with PCC is advantageous.

Benefits:

We provide competitive compensation along with a comprehensive benefits package, which includes: fully paid vacation/sick leave, medical/dental/vision coverage, 401k, flexible spending accounts, health savings accounts, short-term and long-term disability, accident and critical illness insurance, life insurance, and accidental death and dismemberment coverage.

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