Regional Director of Case Management and Reimbursement

6 days ago


Woburn, Massachusetts, United States Marquis Health Services Full time
Regional Director of Case Management and Reimbursement

We are seeking a seasoned professional to lead our Case Management and Reimbursement teams in our Massachusetts market. The ideal candidate will work closely with our VP of Case Management to ensure the implementation of company policies and procedures related to Medicare and Managed Care reimbursement and care management.

Key Responsibilities:
  • Ensure regulatory compliance and quality improvement efforts to attain appropriate Medicare or Managed Care reimbursement.
  • Integrate information from all necessary disciplines to maintain accuracy and compliance with the MDS process and care coordination.
  • Conduct concurrent MDS reviews to achieve maximum allowable HIPPS/RUG categories and appropriate length of stay management through effective care coordination.
  • Collaborate with facility team members to ensure services meet or exceed federal, state, and company standards.
  • Provide consultation, training, and support concerning MA Medicaid, Medicare, Managed Care, and state case mix payment systems.
  • Analyze systems and processes to determine compliance with federal and state regulations and company policies.
  • Oversee and complete PDPM and MDS OBRA completion as needed, ensuring compliance and reimbursement maximization.
  • Study, analyze, and report period-over-period information to identify trends and deviations from expected results.
  • Work with teams to resolve issues affecting deviations from expected results and recommend changes for implementation.

Requirements:

  • RN or LPN licensure
  • Multisite Skilled Nursing center management experience
  • Strong analytical and problem-solving skills
  • Excellent communication and leadership abilities

Salary: Competitive and based on experience.



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