Regional Director of Clinical Reimbursement

Atrium Centers•Grand Rapids, MI

4d•Onsite

About The Position

The Regional Director of Clinical Reimbursement provides education, training, and support to regional and center staff on the resident assessment instrument (RAI) process in accordance with all laws, regulations and standards. This role reviews and coordinates PDPM, Medicare management, managed care, and case mix data for assigned areas to ensure appropriate utilization of available resources. The position collaborates with corporate, regional, and center interdisciplinary teams.

Requirements

Registered Nursing Degree (or diploma) from an accredited college
At least 5 years working with RAI process and PDPM at the regional or above level.
Multi-facility experience required.
Experience in Case Mix required if covering Ohio, Kentucky, or Wisconsin.
Must have adequate computer skills, to accurately input data into the MDS and transmit that data; complete spread sheets; ability to navigate the CMS and other state resource sites; ability to communicate via email; and to pull reports from various computerized sources.
Must possess effective leadership skills, demonstrate organizational skills, and must have knowledge of state and federal regulations for long-term care.

Responsibilities

Monitors RAI processes (MDS accuracy, care plans, quality measures, care mapping, utilization review meeting, triple check, etc.)
Oversees improvement plans for RAI processes as needed in assigned centers.
Participate in the Quality Improvement and Corporate Compliance Programs as assigned.
Assist in ensuring that quality improvement measures are continually maintained.
Maintain an open rapport with all staff and departments to ensure that a team effort is achieved in providing superior services in each center.
Understand and abide by the Corporate Standards of Conduct policies.
Understand, comply with, and promote the Resident Bill of Rights.
Maintain resident confidentiality and privacy.
Promptly report all resident complaints, accidents, and incidents.
Follow Atrium Centers policies and procedures written and utilized to comply with these standards
Lead and/or participate in company initiative projects
Participate in recruitment, selection, and training of center MDS staff.