Job Description
Balance Life & Work with a New Career Opportunity
(LONG TERM CARE)
(SHORT TERM REHAB)
(SKILLED NURSING)
(ASSISTED LIVING)
(LTACH)
(SUB ACUTE CARE)
Now Hiring - Vice President of Clinical Reimbursement - Fort Lee, NJ
The Vice President of Clinical Reimbursement assures the management of the Medicare, Managed Care and Medicaid reimbursement system for a region-specific number of skilled nursing facilities. This position reports directly to the Vice President of Clinical Reimbursement. In this role you will be responsible for regulatory compliance and quality improvement efforts, in order to attain the appropriate Medicaid/Medicare reimbursement possible for assigned facilities. You will ensure that the services offered exceed federal, state, and company standards, and serve as a role model for ethical business practices according to standards.
Essential Duties and Responsibilities:
- Provides consultation, training and support concerning Medicare, Managed Care and state case mix payments systems.
- Provides mentoring guidance to Regional Clinical Reimbursement team and center MDS staff.
- Analyzes systems and processes to determine that Federal and State regulations as well as company policies and procedures are followed.
- Promotes compliance by performing and/or reviewing periodic audits of MDS assessments, supporting documentation, and other relevant data to ensure scheduling and competition are in compliance with RAI process and any related state and/or federal regulations include CAA's and the care planning process.
- Recognizes, advises and promotes facility best practices and systems for dealing with state case mix/Medicare and Managed Care payment systems.
- Studies, analyze and reports period over period information and systems in order to identify trends Medicare, Managed Care and State Case Mix Index and takes appropriate actions.
- Works in conjunction with teams to resolve issues effecting deviations from expected results. Recommends changes and performs follow-ups to ensure that those recommendations are effectively implemented and monitored for appropriateness.
- Monitor Quality Measure and QRP rankings and assist center as needed in root cause analysis and PI.
- Oversee case management, including all aspects of care coordination, care transition and compliance guidelines with various managed care payors.
- Oversees and assist with denials management in organizing and preparing charts for ADRs and providing teaching for identified areas.
- Regularly communicates to center Administrator senior management on recommendations made to facility to ensure proper implementation and follow-up.
- Serves as a liaison between the state and organization related to state case-mix process, including electronic submissions and state MDS requirements related to state payment.
- Assists in the recruitment/interview/orientation process for MDS and Case Management Vacancies.
- Assist with Special Projects as assigned.
Position Requirements: - Bachelor's degree in nursing
- Licensed Registered Nurse (RN) within the state of operations
- Minimum of 5 years of experience in long term care.
- Proven knowledge of quality improvement processes with an emphasis on Medicare, Managed Care and NJ Case mix for Skilled Nursing facilities.
- Multi facility experience with management skills
- Excellent oral and written communication skills.
- Work processing and related computer skills.
- Current licensing and credentials as required.
About Us The CareOne mission is to define excellence within the health care community. We are dedicated to Maximizing Patient Outcomes. We treat Residents, their families and each other with respect, dignity and compassion. Through a collaborative and consultative approach, we strive to provide a framework of strength and stability for our Centers and Communities. We work to maintain the highest standards of care and service for Residents, families and our valued employees.
We are proud to Offer:
- Competitive Salary
- Comprehensive Healthcare Benefits
- 401k Retirement Plan
- Paid Time Off
- Opportunities to advance and grow your career
- And More
If working with people who are dedicated, compassionate, and concerned about their patients is essential to you, then you'll appreciate being a part of our team. We've built a strong reputation on the outstanding level of care that we provide. We have a graciously appointed facility with strong belief in patient care and service; join us at our beautiful facility!
We are an Equal Opportunity Employer
EEO/AA/M/F/DV
