Director of Clinical Reimbursement

Cura Health•Le Sueur, MN

8d•$88,000 - $95,000

About The Position

The Director of Clinical Reimbursement oversees and coordinates resident assessments and care planning in a skilled nursing facility, ensuring assessments, documentation, and care plans accurately reflect each resident’s clinical needs, functional abilities, and services. The role coordinates the Minimum Data Set (MDS) and Resident Assessment Instrument (RAI) processes, supports regulatory compliance, and helps ensure appropriate reimbursement. The Director works closely with nursing, therapy, social services, dietary, activities, providers, and other interdisciplinary team members, and contributes to quality outcomes and facility operations.

Requirements

Current and active Registered Nurse (RN) license in the state of 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 handle sensitive resident information appropriately.
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 needed.
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.