Clinical Reimbursement Mgr - RN

Vi LivingHilton Head Island, SC
Onsite

About The Position

This is a salaried position with a compensation range of $82,487.45 - $107,228.73 or MORE based on experience. The schedule is Monday - Friday with an on-call weekend rotation every 4 weeks. Relocation can be discussed. Vi is recognized as a Great Place to Work and one of Glassdoor's 100 Best Companies to work for. Learn from the best and accelerate your career with Vi. The role is located at TidePointe, a Vi Community, at 700 TidePointe Way, Hilton Head Island, SC 29928.

Requirements

  • Graduation from a School for Registered Nurses is required.
  • Minimum 3 years of previous experience in an MDS/Clinical Reimbursement Nurse role is required.
  • Current State Licensure as a Registered Nurse in the state where practicing is required.
  • Current CPR and Automated External Defibrillator (AED) certifications are required.
  • Current First Aid certification is required or must be willing and able to become First Aid certified.
  • Food handlers certification, where required.
  • Maintains a courteous and professional manner through interactions with others.
  • Uses a resident and customer-focused approach to problem solving and goal setting.
  • Uses discretion in handling confidential information, incorporating all Federal, State and local privacy and confidentiality requirements.
  • Must possess knowledge of regulatory compliance and Continuing Care Retirement Community operations.
  • Excellent knowledge of Case-Mix, and the Federal Medicare PPS process as required.
  • Thorough understanding of the Quality Indicator Process, and OBRA regulations.
  • Excellent oral and written communication skills and ability to interface and maintain effective relationships with all departments and employees in a team-oriented environment.
  • Computer proficiency using Microsoft Office.
  • Must be sensitive to the needs of older adults and enjoy working with a senior population.

Responsibilities

  • Collaborates with the DON, Clinical Reimbursement Specialist (where applicable) and various disciplines to complete the Minimum Data Set (MDS), Resident Assessment Instrument (RAI), and all associated processes.
  • Ensures completion of the assessment within the timeframe as mandated by federal regulations and company policies, with guidance and oversight from the DON.
  • Manages the overall process and tracking of all Medicare/Managed Care/Medicaid case mix documents to ensure appropriate and optimal reimbursement for services provided within the Care Center.
  • Assists with the coordination of the resident care planning processes.
  • Reviews the clinical records, MD progress notes, therapy and nursing documentation in order to capture all care and services for optimal reimbursement.
  • Ensures that participants in the assessment process complete an accurate and comprehensive assessment and collaborates with the Clinical Reimbursement Specialist (where applicable) or DON to address concerns.
  • Tracks Medicare/Managed Care beneficiaries to determine continued and appropriate Medicare eligibility and benefit period by determining skilled level of need.
  • Performs concurrent and ongoing MDS review to ensure appropriate PDPM category is achieved through the capture of appropriate clinical information.
  • Manages the coordination of ICD-10 coding for Medicare and Managed Care billing.
  • Directs the interdisciplinary team process to communicate opportunities to ensure capturing of all care, services, and diagnosis.
  • Coordinates with rehabilitation services Program Director, Corporate Director of Clinical Reimbursement and Central Billing Office as needed to communicate case mix data required for accurate claim billing at month end.
  • Reviews additional document requests by local Medicare Administrative Contractors, insurance carriers or auditors to ensure appropriate documentation is submitted timely for review.
  • Encourages staff to report changes in the resident's status and involves the DON in addressing concerns.
  • Confirms that residents and their families are actively involved in the information sharing and decision-making process.
  • Completes resident assessment protocol documents within scope of practice.
  • Assists with the completion of the resident care plan and the care plan conferences per requirements as requested by the DON.
  • Provides resident and family education as needed.
  • Identifies and reports deviations from safe practice to the DON.
  • Adheres to policies and guidelines of regulatory agencies (i.e. OSHA, CMS).
  • Manages emergency situations based on the Company’s safety and disaster policies.
  • Communicates and collaborates with other members of the healthcare team to resolve resident care problems and to enhance care delivery.
  • Participates in quality assessment/performance improvement activities and audits.
  • Maintains minimum data set competencies and attends annual educational programs.
  • Attends/participates in care center meetings, in-services and committee meetings.
  • May perform CPR, use Automated External Defibrillator (AED), and render first aid in emergency situations.

Benefits

  • Competitive pay
  • Exceptional benefits
  • Generous Paid Time Off - start accruing on day one
  • 401k with company match
  • Paid maternity and paternity benefits
  • Award-winning training and development
  • Tuition Reimbursement
  • Luxury work environment
  • Meaningful and rewarding work
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