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Care Initiatives is seeking a Director of Clinical Reimbursement. As the largest single operator of quality nursing homes in Iowa, Care Initiatives has over forty (40) skilled nursing communities, seven (7) hospice offices (and growing!), plus our own internal staffing agency. We are committed to providing exceptional care and support at every stage of the healthcare journey.

The Director of Clinical Reimbursement is responsible for overseeing and optimizing the Minimum Data Set (MDS) and Patient-Driven Payment Model (PDPM) across our skilled nursing communities. Reporting to the Chief Operating Officer, this role is responsible for ensuring regulatory compliance and optimizing reimbursement strategies. This role is remote with field-based travel throughout the state of Iowa with overnight stays.

Key responsibilities of the Director of Clinical Reimbursement:

+ Provide expertise and guidance to ensure MDS accuracy and adherence to company policy and procedures, as well as state and federal regulations and guidelines based on information derived from audits and other available data.

+ Serve as the subject matter expert for the Company on all areas related to Clinical Reimbursement, RAI, QRP, Five Star, VBP and any other new reimbursement programs.

+ Develop and research reimbursement and regulatory issues including federal register and final rules.

+ Identify documentation compliance for proper billing and optimize reimbursement outcomes

+ Audit and monitor integrity of:

+ Overall RAI process

+ Medicare, Medicaid, VA and Managed Care program requirements

+ PDPM Management

+ Complete Data Analysis in quality measures and reimbursement performance

+ Deliver staff training/education on MDS, clinical documentation, and quality measures

What it takes to become the Director of Clinical Reimbursement:

+ Bachelor’s degree in health-related field or equivalent work experience.

+ Active RN license in the state of Iowa.

+ RAC-CT preferred

+ 2+ years of management experience with strong leadership background preferred

+ Five (5)+ years of clinical reimbursement or MDS experience in long term care and skilled nursing.

+ Extensive knowledge of MDS/RAI, Medicare reimbursement, PDPM systems, compliance and Medicaid Clinical Reimbursement RUGS/CMI.

+ Remote position with ability to travel throughout Iowa with overnight stays as needed.

Why choose Care Initiatives? Here are just a few reasons:

+ Unlimited vacation time.

+ Robust benefit options including medical, dental, vision, retirement savings, Basic Life and AD&D, Voluntary Life AD&D, Short-Term and Long-Term Disability.

+ On-demand pay... and more!

Committed to attracting and retaining a diverse staff, Care Initiatives will honor your experiences, perspectives, and unique identity. Together, our community strives to create and maintain working and learning environments that are inclusive, equitable, and welcoming.

Care Initiatives is an Affirmative Action and Equal Opportunity Employer. Care Initiatives complies with applicable federal civil rights laws and does not discriminate based on race, color, religion, national origin, age, disability, sex, sexual orientation, gender identity, gender expression, marital status, parental status, genetic information, protected veteran status, or any other characteristic protected by law.

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