RN Manager Clinical Reimbursement

Day Shift / 40hrs/wk

The Manager Clinical Reimbursement is responsible for coordinating, managing and ensuring the accuracy/capitalization of the facility’s reimbursement from its payor sources.  Responsible for the coordination of the Resident Assessment Instrument (RAI) process.

Essential Duties and Responsibilities:

• Manages the facility’s RAI processes to capture accurate resident related data as well as work with all resident service department s involved in the RAI process to maximize resident’s full reimbursement potential.
• Provides/ensures accurate documentation of all services in order to maximize accurate reimbursement from all payor sources.
• Completes all performance reviews with staff along with hiring of new staff.
• Selects, trains/orients and assigned department staff.        Develops standards of performance, evaluates performance, and initiates or makes staff recommendations.
• Reviews facility quality indicators, assisting  as needed with identifying strengths and weaknesses of data and how it relates to facility care practices
• Manages the patient’s Medicare benefit by communication of skilled needs to the patient, family and interdisciplinary care team.  
• Organize and participate in the daily Medicare meeting, utilization review and monthly end of close meetings.  
• Assists with Medicare denial claims/reviews when need is identified by billing office.
• Keeps abreast of changes in the Medicare, Medicaid and managed care areans and MDS/RAI processes through journal reading, outside in-services an other sources.
• Continually upgrades and makes changes in job area to assure that departments meet the needs to the changing market, federal and/or state mandates.
• Participates in and attends all mandatory Masonicare in services and departmental staff and inservice meetings.

Education:                  Requires a Registered Nurse with a current Connecticut State license and a BSN or MSN graduate degree from an accredited school of nursing.

Experience:                 Requires at least 3-5 years experience in geriatric nursing; 

Requires at least two (2) years experience with federal Medicare/Medicaid and Managed Care reimbursement systems with a thorough working knowledge  of the MDS and RAI process; Requires a working knowledge of OBRA regulations as they relate to Skilled Nursing facilities; Requires strong working knowledge of statistics, data collection, analysis and presentation.

Certificates, Licenses, Registrations: Current Connecticut State RN licensure required.

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