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Regional Managed Care Specialist
2 months ago
Regional CaseMix Specialist
Nexion Health Management
Houston, TX
This role is centered around a corporate framework within the Houston vicinity.Nexion affiliates manage a network of skilled nursing and rehabilitation facilities, as well as assisted living centers across multiple states. Each facility is designed to provide a homely atmosphere, influenced by the distinct regional cultures of their locations. Our dedication to quality is demonstrated through outstanding clinical outcomes, positive feedback from residents and families, satisfaction metrics, and recognition through various quality awards.
Position Overview:
The main objective of this position is to oversee the provision of services to residents under managed care and Medicare, working in tandem with the facility's team members. The Regional CaseMix Specialist is responsible for monitoring and documenting the cost-effectiveness of the treatments provided, facilitating the admission and discharge processes, advocating for residents and their families, and serving as a liaison with insurance and medical management professionals. Travel to designated facilities is required.
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 the utilization of Medicare and Medicaid services in accordance with established guidelines. Possess a strong understanding of MDS coding and guide facilities in accurate coding and selection for MDS assessments. Participate in state Medicaid audits and maintain knowledge of state-specific regulations. Supervise the CaseMix Managers to ensure adherence to the outlined responsibilities. Ensure that the quality and appropriateness of resident care meet or exceed company and industry standards, and that all nursing services comply with legal, regulatory, accreditation, and reimbursement guidelines. Foster effective communication among program staff, facility personnel, referral sources, physicians, and residents. Access resources from the company's regional offices for consultation and program development support, and seek external resources through conferences and workshops as necessary. Share knowledge with staff and facility personnel. Exhibit adaptability in response to changes, resident needs, and customer expectations, while meeting company standards for 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 web-based applications. Willingness to travel extensively, including some overnight stays. Experience with PCC is advantageous.Benefits:
We provide a competitive salary and a comprehensive benefits package, which includes: fully paid vacation and sick leave, medical, dental, and vision coverage, 401k plan, flexible spending accounts, health savings accounts, short-term and long-term disability insurance, accident and critical illness benefits, life insurance, and accidental death and dismemberment coverage.
