Executive Director of Clinical Reimbursement

4 weeks ago

NORCROSS Georgia, Gwinnett County, GA, United States PruittHealth Full time

JOB PURPOSE:

The Executive Director of Clinical Reimbursement leads and oversees the clinical reimbursement process across the organization’s long-term care and post-acute care facilities. This role ensures compliance with federal and state regulations, optimizes reimbursement strategies, and drives operational excellence in clinical documentation and billing practices. The Executive Director serves as a strategic partner, working closely with interdisciplinary teams to maximize revenue integrity while maintaining the highest standards of patient care.

KEY RESPONSIBILITIES:

· Develop, implement, and oversee company-wide clinical reimbursement strategies, policies, and best practices.

· Analyze reimbursement trends and identify opportunities to enhance revenue performance while aligning with regulatory requirements.

· Provide guidance on Medicare, Medicaid, Managed Care, Skilled Intensity and other payer reimbursement processes.

· Leads the RAI Process and the use of various supporting software applications to ensure an appropriate level of Resident care and equitable and timely reimbursement of the care provided.

· Provides expertise, consultation and guidance to appropriate partners to ensure MDS accuracy and adherence to company policy and procedures, as well as state and federal regulations and guidelines based on information derived from audits and other available data

· Must possess and ensure operational excellence.

· Lead the training and development of regional and facility-level clinical reimbursement teams, including MDS coordinators, business office staff, and administrators.

· Monitor and evaluate reimbursement metrics to ensure optimal performance and compliance.

· Establish processes to improve accuracy in coding, documentation, and Minimum

· Adheres to and oversees communication of privacy guidelines relative to the confidentiality of residents’ protected health information.

· Participates in PI activities as appropriate

· Overnight travel may be required.

KNOWLEDGE, SKILLS, ABILITIES:

• Expert knowledge e of state and federal regulations, both clinical and financial as it relates to the RAI process and reimbursement systems.

• Current Licensed Registered Nurse or Allied Health Care Professional in state of residence. Credential Nurse Assessment Coordinator preferred.

• Experience in MatrixCare, Pointright a plus

Extended use of Microsoft office products


Qualifications - External

MINIMUM EDUCATION REQUIRED:

Bachelors’ degree from an accredited school of Nursing or other Allied Health Care Institution

MINIMUM EXPERIENCE REQUIRED:

Ten years- (10) years health care management, MDS Assessment & care Planning experience in multi-facility, long-term care organizations preferred.

Five (5+) years clinical responsibility and experience with RAI process (MDS) required

MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:

Current, active license as a Registered Nurse or Allied Health Professional -Compact License required.

Family Makes Us Stronger. Our family, your family, one family. Committed to loving, giving, and caring. United in making a difference.

We are eager to connect with you Apply Now to get started at PruittHealth

As an Equal Employment Opportunity employer, all qualified applicants will receive consideration without regard to race, color, religion, sex, national origin, disability, or veteran status.

  • Director-Rehab Clinical

    4 weeks ago

    Duluth, Georgia, 30097, Gwinnett County, GA, United States Powerback Rehabilitation Full time

    Overview: At Powerback, we're on a mission to improve lives. As the leader in physical, occupational, speech, and respiratory therapies, we help older adults stay active and thrive while providing essential therapy for children at home and in school.With over 38 years of trusted service, our reach spans skilled nursing centers, assisted and independent...

  • Hospice Clinical Manager RN Full Time

    4 weeks ago

    Duluth , Georgia, 30096, Gwinnett County, GA, United States Aveanna Healthcare Full time

    Position Overview: The Clinical Manager – Hospice works under the direction and guidance of the Branch Administrator to provide supervision of all clinical staff working with high medical acuity clients and/or clients receiving extended non‐licensed support services. This leader is responsible to provide staff orientation and ensure competence as a...

  • Director Therapy Operations

    4 weeks ago

    Montgomery, Georgia, Chatham County, GA, United States Encompass Health Part time

    Director of Therapy Operations Career Opportunity Highly regarded and esteemed for your Director of Therapy Operations expertiseAre you a dedicated and experienced leader in Therapy, seeking a career opportunity that allows you to make a meaningful impact close to both your home and your heart? As the Director of Therapy Operations at Encompass Health,...

  • Home Health Physical Therapist Full Time

    4 weeks ago

    Duluth , Georgia, 30096, Gwinnett County, GA, United States Aveanna Healthcare Full time

    Position OverviewAveanna Healthcare has grown tremendously during the past year through a series of exciting acquisitions and we are currently looking for a Physical Therapist (PT) to join our dynamic home health care team. In this position, you make it possible for patients to recuperate from illness or injury in the comfort of their own home.Territory:...

  • Senior Director, Brand Marketing Asia

    4 weeks ago

    Atlanta, Georgia, 30383, DeKalb County, GA, United States CONVERSE Full time

    WHO WE ARE LOOKING FORWe are looking for a Senior Director to lead our Brand Marketing function for the Asia geography.We are looking for someone to lead the marketing activation and strategy with a clear vision grounded in tangible consumer insights. You will ensure robust integration of Brand and Business through effective processes and strategies. You...

  • Account Executive

    4 weeks ago

    Augusta, Georgia, 30909, Columbia County, GA, United States Georgia Hospice Care Full time

    Overview: Become a Hospice Liaison with Georgia Hospice CareDo you have a knack for coordinating, organizing, and making connections? Are you ready to make a difference in the lives of others and in the community? We are looking for hospice liaisons who are committed to serving our patients with compassion and integrity. As a hospice liaison, you will be...

  • RN - ICU, Days

    3 weeks ago

    Snellville, Georgia, 30278, Gwinnett County, GA, United States Piedmont Eastside Medical Center Full time

    Description:(Registered Nurse, Piedmont Eastside, ICU, Full Time Days)Sign on Bonus available up to $10,000Experience the advantages of real career change Join Piedmont to move your career in the right direction. Stay for the diverse teams youll love, a shared purpose, and schedule flexibility that frees you to live for what matters both in and outside of...

  • Travel Med Surg RN

    4 weeks ago

    Duluth, Georgia, 30096, Gwinnett County, GA, United States Fusion Medical Staffing Full time

    Facility DetailsFacility: Please Contact for facility infoJob DetailsStarts: 03/17/2025Assignment Length: 13Shift: DaysCall Off Policy: Please Contact for InfoJob Quantity: 1Type: TravelJob Description Interested in making a positive impact? You’ve come to the right place. At Fusion Medical Staffing, our goal is to improve the lives of everyone we touch,...

  • Travel PACU RN

    4 weeks ago

    Lawrenceville, Georgia, 30046, Gwinnett County, GA, United States Fusion Medical Staffing Full time

    Facility DetailsFacility: Please Contact for facility infoJob DetailsStarts: 03/17/2025Assignment Length: 13Shift: Not IndicatedCall Off Policy: Please Contact for InfoJob Quantity: 1Type: TravelJob Description Interested in making a positive impact? You’ve come to the right place. At Fusion Medical Staffing, our goal is to improve the lives of everyone we...

  • Travel PCU Stepdown RN

    4 weeks ago

    Duluth, Georgia, 30096, Gwinnett County, GA, United States Fusion Medical Staffing Full time

    Facility DetailsFacility: Please Contact for facility infoJob DetailsStarts: 03/17/2025Assignment Length: 13Shift: DaysCall Off Policy: Please Contact for InfoJob Quantity: 1Type: TravelJob Description Interested in making a positive impact? You’ve come to the right place. At Fusion Medical Staffing, our goal is to improve the lives of everyone we touch,...

  • Travel OR RN

    4 weeks ago

    Lawrenceville, Georgia, 30046, Gwinnett County, GA, United States Fusion Medical Staffing Full time

    Facility DetailsFacility: Please Contact for facility infoJob DetailsStarts: 03/17/2025Assignment Length: 13Shift: DaysCall Off Policy: Please Contact for InfoJob Quantity: 1Type: TravelJob Description Interested in making a positive impact? You’ve come to the right place. At Fusion Medical Staffing, our goal is to improve the lives of everyone we touch,...

  • Travel Med Surg RN

    4 weeks ago

    Cumming, Georgia, 30041, Gwinnett County, GA, United States Fusion Medical Staffing Full time

    Facility DetailsFacility: Please Contact for facility infoJob DetailsStarts: 03/17/2025Assignment Length: 13Shift: NightsCall Off Policy: Please Contact for InfoJob Quantity: 1Type: TravelJob Description Interested in making a positive impact? You’ve come to the right place. At Fusion Medical Staffing, our goal is to improve the lives of everyone we touch,...

  • Travel ER RN

    4 weeks ago

    Snellville, Georgia, 30078, Gwinnett County, GA, United States Fusion Medical Staffing Full time

    Facility DetailsFacility: Please Contact for facility infoJob DetailsStarts: 03/10/2025Assignment Length: 12Shift: NightsCall Off Policy: Please Contact for InfoJob Quantity: 1Type: TravelJob Description Interested in making a positive impact? You’ve come to the right place. At Fusion Medical Staffing, our goal is to improve the lives of everyone we touch,...

  • Travel RN Case Manager

    4 weeks ago

    Lawrenceville, Georgia, 30046, Gwinnett County, GA, United States Fusion Medical Staffing Full time

    Facility DetailsFacility: Please Contact for facility infoJob DetailsStarts: 03/17/2025Assignment Length: 13Shift: DaysCall Off Policy: Please Contact for InfoJob Quantity: 1Type: TravelJob Description Interested in making a positive impact? You’ve come to the right place. At Fusion Medical Staffing, our goal is to improve the lives of everyone we touch,...

  • Travel ICU RN

    4 weeks ago

    Lawrenceville, Georgia, 30046, Gwinnett County, GA, United States Fusion Medical Staffing Full time

    Facility DetailsFacility: Please Contact for facility infoJob DetailsStarts: 03/17/2025Assignment Length: 13Shift: NightsCall Off Policy: Please Contact for InfoJob Quantity: 1Type: TravelJob Description Interested in making a positive impact? You’ve come to the right place. At Fusion Medical Staffing, our goal is to improve the lives of everyone we touch,...

  • Travel CVICU RN

    4 weeks ago

    Lawrenceville, Georgia, 30046, Gwinnett County, GA, United States Fusion Medical Staffing Full time

    Facility DetailsFacility: Please Contact for facility infoJob DetailsStarts: 03/17/2025Assignment Length: 13Shift: DaysCall Off Policy: Please Contact for InfoJob Quantity: 1Type: TravelJob Description Interested in making a positive impact? You’ve come to the right place. At Fusion Medical Staffing, our goal is to improve the lives of everyone we touch,...

  • Travel PACU RN

    4 weeks ago

    Lawrenceville, Georgia, 30046, Gwinnett County, GA, United States Fusion Medical Staffing Full time

    Facility DetailsFacility: Please Contact for facility infoJob DetailsStarts: 03/17/2025Assignment Length: 13Shift: DaysCall Off Policy: Please Contact for InfoJob Quantity: 1Type: TravelJob Description Interested in making a positive impact? You’ve come to the right place. At Fusion Medical Staffing, our goal is to improve the lives of everyone we touch,...

  • Travel NICU RN

    4 weeks ago

    Snellville, Georgia, 30078, Gwinnett County, GA, United States Fusion Medical Staffing Full time

    Facility DetailsFacility: Please Contact for facility infoJob DetailsStarts: ASAPAssignment Length: 14Shift: NightsCall Off Policy: Please Contact for InfoJob Quantity: 1Type: TravelJob Description Interested in making a positive impact? You’ve come to the right place. At Fusion Medical Staffing, our goal is to improve the lives of everyone we touch, and...

  • Travel CT Technologist

    4 weeks ago

    Duluth, Georgia, 30096, Gwinnett County, GA, United States Fusion Medical Staffing Full time

    Facility DetailsFacility: Please Contact for facility infoJob DetailsStarts: 03/17/2025Assignment Length: 13Shift: DaysCall Off Policy: Please Contact for InfoJob Quantity: 1Type: TravelJob Description Interested in making a positive impact? You’ve come to the right place. At Fusion Medical Staffing, our goal is to improve the lives of everyone we touch,...

  • Travel CT Technologist

    4 weeks ago

    Lawrenceville, Georgia, 30046, Gwinnett County, GA, United States Fusion Medical Staffing Full time

    Facility DetailsFacility: Please Contact for facility infoJob DetailsStarts: 03/17/2025Assignment Length: 13Shift: DaysCall Off Policy: Please Contact for InfoJob Quantity: 1Type: TravelJob Description Interested in making a positive impact? You’ve come to the right place. At Fusion Medical Staffing, our goal is to improve the lives of everyone we touch,...