Director of Clinical Reimbursement

Cura Health•Le Sueur, MN

About The Position

At Cura of Le Sueur, the Director of Clinical Reimbursement is a member of the nursing leadership team who oversees the resident assessment process and helps ensure assessments, documentation, and care plans accurately reflect each resident’s needs. The role coordinates completion of the Minimum Data Set (MDS) and Resident Assessment Instrument (RAI) process in accordance with federal and state requirements and established timelines. It works closely with nursing, therapy, social services, dietary, activities, providers, and other interdisciplinary team members to support accurate assessments, individualized care planning, regulatory compliance, quality outcomes, and appropriate reimbursement. The position requires strong clinical judgment, attention to detail, organization, and an understanding of MDS, Medicare, Medicaid, PDPM, and skilled nursing reimbursement. The Director reviews clinical documentation, identifies gaps, supports staff education, monitors assessment deadlines and resident condition changes, and assists with audits, surveys, and quality improvement efforts. The role also maintains resident confidentiality and performs related MDS, care-planning, and clinical-operations duties as assigned.

Requirements

Current and active Registered Nurse (RN) license in Minnesota.
Strong clinical assessment and critical-thinking skills.
Excellent attention to detail and ability to maintain accurate documentation.
Strong organizational and time-management skills, including the ability to manage multiple deadlines.
Ability to interpret clinical documentation and communicate effectively with interdisciplinary team members.
Strong written and verbal communication skills.
Comfort working with electronic health records and other healthcare documentation systems.
Ability to maintain confidentiality and appropriately handle sensitive resident information.
Must meet all applicable background check, health, and employment requirements.

Nice To Haves

Previous nursing experience in a skilled nursing or long-term care setting.
Previous MDS experience.
Knowledge of MDS 3.0 and the RAI process.
Understanding of Medicare, Medicaid, PDPM, and skilled nursing reimbursement.

Responsibilities

Coordinate and complete MDS assessments in accordance with federal and state requirements and established timelines.
Manage the RAI process and maintain an accurate MDS assessment schedule.
Ensure assessments are accurate, thorough, and submitted within required timeframes.
Collaborate with the interdisciplinary team to gather information for resident assessments and care planning.
Coordinate and participate in comprehensive resident care planning.
Review clinical documentation to ensure resident conditions, services, treatments, and functional abilities are accurately reflected.
Identify documentation gaps and work with nursing and other departments to improve documentation accuracy and consistency.
Monitor Medicare and skilled nursing documentation to support medical necessity and appropriate reimbursement.
Maintain knowledge of current MDS, RAI, Medicare, Medicaid, PDPM, and CMS requirements.
Review resident information for appropriate coding and reimbursement classifications.
Track assessment reference dates, completion dates, submissions, and other required MDS deadlines.
Complete required modifications, corrections, and assessments when necessary.
Monitor changes in resident condition and determine when additional assessments or care plan updates may be required.
Work with therapy and nursing to ensure services and resident needs are accurately captured.
Participate in interdisciplinary meetings, quality improvement initiatives, and other clinical meetings as needed.
Assist with audits, surveys, documentation reviews, and requests for supporting clinical information.
Educate nursing staff and other team members about documentation requirements and MDS-related processes.
Maintain resident confidentiality and comply with HIPAA and facility policies.
Support facility efforts related to quality measures, resident outcomes, regulatory compliance, and reimbursement accuracy.
Perform additional duties related to MDS, care planning, and clinical operations as assigned.