• RN Manager Clinical Reimbursement

    Masonicare (Wallingford, CT)


    RN Manager Clinical Reimbursement Job Location: Wallingford Center, Connecticut

     

    RN Manager Clinical Reimbursement

     

    Masonicare Health Center - Wallingford, CT

     

    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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    Job ID: 12926

     

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