Clinical Reimbursement Manager

New Perspective•Minnetonka, MN

7d•$65,000 - $75,000

About The Position

Why New Perspective Senior Living? A career with a purpose starts here! This is an exciting time to join New Perspective. We are a growing company serving over 4,000 seniors today with a goal of reaching 10,000. Our growth is creating energy, excitement, and the opportunity to make a difference in the lives of others. We have a culture of servant leadership and collaboration that supports each team member’s personal and professional development. At New Perspective you’re not just an employee, you are a valued member of our team. The Clinical Reimbursement Manager (“CRM”) provides oversight and direction to Community team members in creating and maintaining accurate documentation that supports billing for resident beneficiaries of Medicaid government assistance. Working in collaboration with the Director of Quality and Compliance, the CRM provides training, auditing, and oversight of clinical assessments and associated documentation conducted and maintained by Community licensed nurses in support of receipt of reimbursement for services identified within prescribed government payor reimbursement protocols.

Requirements

Holds and maintains a Minnesota registered nurse license in good standing.
Associate Degree in Nursing or higher required.
3-5 years of experience working as a registered nurse in a long-term setting
Minimum of one (1) year experience with Medicaid reimbursed services including completion of Medicaid Rate Sheets
Experience working with government payor case management, such as Elderly Waiver and CADI, and/or completing Rate Sheets
Proficient clinical assessment and documentation skills
Strong interpersonal and organizational skills with the ability to work independently as well as collaboratively
Proficient in working with electronic health records
Proficient in written and verbal communication
Ability to travel to complete site visits (Travel anticipated at 30-40% with minimal overnight stays)

Nice To Haves

Previous experience as a trainer preferred
Proficient in working in Excel preferred

Responsibilities

Conduct and maintain documentation of monthly and quarterly government beneficiary reimbursement reviews and case manager communications files to support maximization of reimbursement within government payor protocols
Conduct community site visits to provide team member training on government reimbursement processing protocols to include accurate completion of applicable Customized Living tools
Create and maintain community beneficiary case manager communications files and case manager contacts information
Communicate and collaborate with community team members and Medicaid case managers in support of timely and accurate reimbursement
Complete annual reviews of Medicaid beneficiary comprehensive assessments and service plans to identify areas of deficit(s) in assessments or documentation
Train nurses at various levels of proficiency in management of government payor reimbursement protocols
Audit, track, and trend government beneficiary reimbursement metrics for impact on quality resident services delivery and regulatory compliance with reimbursement protocols and opportunities for process improvement
Participate in corporate and community level government reimbursement associated quality initiatives to include initiatives targeting timely and accurate completion of comprehensive and customized living tool assessments and service plans
In collaboration with Director of Quality and Compliance, timely remediate identified process improvement needs to include perceived irregularities in documents necessary to support government reimbursement
Draft biannual and annual government payor reimbursement reports for review by community, district, and executive leadership
Collaborate in the development and/or improvement of government reimbursement team member training materials