Regional Director of Reimbursement at Caraday Healthcare

San Marcos, Texas, United States -

Full Time

Start Date

Immediate

Expiry Date

12 Jan, 26

Salary

0.0

Posted On

14 Oct, 25

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Nursing, Healthcare Management, Compliance, Care Management, Training Development, Clinical Reimbursement, Budget Development, Data Analysis, Regulatory Knowledge, Team Leadership, Operational Management, Quality Assurance, Staff Recruitment, Strategic Planning, Technology Applications, Multi-Facility Management

Industry

Hospitals and Health Care

Description

Description JOB TITLE: Regional Director of Reimbursement JOB CODE: 79 DEPARTMENT: ADMINISTRATIVE FLSA STATUS: EXEMPT REPORTS TO: VP of REIMBURSEMENT DATE OF LAST UPDATE: 12/16/2020 JOB SUMMARY: Responsible for the executive oversight of the administration, clinical planning, development and operations of the Minimum Data Set (MDS) program. This position supports regional and facility employees in all aspects of Care Management. ESSENTIAL FUNCTIONS: Supports the development and compliance of RAI systems through the use of various supporting technological applications to ensure an appropriate level of resident care and timely reimbursement of the care provided. Responsible for the overall management, compliance, leadership, growth and profitability of assigned programs within the division. Uses standardized reports that include analysis and opportunity for discussion, strategizing, planning, implementation, monitoring and action planning. Develops and implements training strategies with the Interdisciplinary Field Support for all payor types including PPS, Managed Care and State Medicaid Case Mix Reimbursement. Develops, implements, monitors and promotes care management systems, models, services, processes and tools at all levels of the organization to assure delivery of quality of care to residents. Participates in CMS and State initiatives as related to nursing facility assessment and reimbursement systems. Provides support to teams for clinical reimbursement strategies, systems implementation, training and team development Manages, monitors and supports all operational, administrative, clinical and fiscal activities of assigned programs and services to ensure quality and consistency with company standards. This includes education and training of all community team members, as needed. Responsible for ensuring that the quality and appropriateness of patient care meets or exceeds company and industry standards and ensures that all services are in compliance with state and federal legal, regulatory, accreditation and reimbursement guidelines. Assists with the development of corrective actions, best practices and/or education to appropriate employees. Conducts community and/or region visits as needed to identify strengths and opportunities. Develops and provides information to identify trends, variances, practice patterns and opportunities for improvement as part of the QAPI process to promote positive outcomes. Recruits, hires, provides orientation/training and retains a sufficient number of qualified staff to carry out the responsibilities or the MDS function. Assists in the development of annual budgets. Develops and manages the implementation of strategies to provide effective and cost-effective regulations. Completes required forms and documents win accordance with company policy and state and/or federal regulations. Performs other duties as assigned. Requirements QUALIFICATIONS: Required Graduate of accredited school of Nursing with at least a bachelor’s degree. Holds a current license to practice as an RN or LVN Three (3) years’ experience managing region or division level positions. Five (5) years health care management in multi-facility, long-term care organizations. Knowledge of state and federal regulations, both clinical and financial, as it relates to RAI process and reimbursement systems. Proficient in the use of Microsoft office products. Frequent travel throughout Texas. Oversee OIG/ADR review process. Ability to work with a sense of urgency to complete tasks. PHYSICAL REQUIREMENTS: The ability to safely perform movements such as pushing, pulling, lifting, bending, kneeling, and reaching up to 50 pounds with or without reasonable accommodations WORK SCHEDULE: As assigned, including some weekends, evenings and holidays WORK ENVIRONMENT: Clinical Caraday Healthcare provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability, genetics, or any other characteristic protected by law.

Responsibilities

The Regional Director of Reimbursement is responsible for the executive oversight of the MDS program, ensuring compliance and quality of care. This role involves managing operational, administrative, clinical, and fiscal activities to support regional and facility employees.