Clinical Reimbursement Manager - RN

Schedule: Monday - Friday 8 - 4:30

Compensation: $80,476.00 - $104,613.00 OR MORE based on experience.

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What We Offer:

• Competitive pay
• Exceptional benefits
• Generous Paid Time Off - start accruing on day one
• 401k with company match
• Paid maternity and paternity benefits
• Award-winning training and development
• Tuition Reimbursement
• Luxury work environment
• Meaningful and rewarding work

TidePointe, a Vi Community, is located at 700 TidePointe Way, Hilton Head Island, SC 29928

Collaborates with the DON, Clinical Reimbursement Specialist (where applicable) and various disciplines to complete the Minimum Data Set (MDS), Resident Assessment Instrument (RAI), and all associated processes. With guidance and oversight from the DON, the CRM ensures completion of the assessment within the timeframe as mandated by federal regulations and company policies. The CRM also manages the overall process and tracking of all Medicare/Managed Care/Medicaid case mix documents in order to ensure appropriate and optimal reimbursement for services provided within the Care Center. Responsibilities also include assisting with the coordination of the resident care planning processes. Performs other duties as assigned. This is a safety sensitive position.

Principal Accountabilities / Essential Job Functions:

• Reviews the clinical records, MD progress notes, therapy and nursing documentation in order to capture all careand services for optimal reimbursement.
• Ensures that participants in the assessment process complete an accurate and comprehensive assessment and collaborates with the Clinical Reimbursement Specialist (where applicable)or DON to address concerns.
• Tracks Medicare/Managed Carebeneficiaries to determine continued and appropriate Medicare eligibility and benefit period by determining skilled level of need.
• Performs concurrent and ongoing MDS review to ensure appropriate PDPM category is achieved through the capture of appropriate clinical information.
• Manages the coordination of ICD-10 coding for Medicare and Managed Care billing.
• Directs the interdisciplinary team process to communicate opportunities to ensure capturing of allcare, services, and diagnosis.
• Coordinates with rehabilitation services Program Director, Corporate Director of Clinical Reimbursement and Central Billing Office as needed to communicate case mix data required foraccurate claim billing at month end.
• Reviews additional document requests by local Medicare Administrative Contractors, insurance carriers or auditors to ensureappropriate documentation is submitted timely for review.

• Encourages staff to report changes in the resident's status and involves the DON in addressing concerns.
• Confirms that residents and their families are actively involved in the information sharing and decision-making process.
• Completes resident assessment protocol documents within scope of practice.
• Assists with the completion of the resident care plan and the care plan conferences per requirements as requested by the DON.
• Provides resident and family education as needed.
• Identifies and reports deviations from safe practice to the DON. Adheres to policies and guidelines of regulatory agencies (i.e. OSHA, CMS).
• Manages emergency situations based on the Company’s safety and disaster policies.
• Communicates and collaborates with other members of the healthcare team to resolve resident care problems and to enhance care delivery.
• Participates in quality assessment/performance improvement activities and audits.
• Maintains minimum data set competencies and attends annual educational programs.
• Attends/participates in care center meetings, in-services and committee meetings.
• May perform CPR, use Automated External Defibrillator (AED), and render first aid in emergency situations.

Physical Requirements:

• Constant: Walking, must have the ability to operate in a constant state of alertness and in a safe manner.
• Frequent: Standing
• Occasional: Handling medical supplies and equipment, pushing up to 120 lbs.
• Seldom: Bending, crouching, pulling, reaching up to 36 in., lifting Residents (70 lbs. to 300 lbs.) with use of assistive device

Sensory Requirements:

• Balance, tactile, hearing, smelling, near, midrange, color and peripheral vision

Working Conditions:

• Regular on-site physical presence is required.

Key Competencies:

• Maintains a courteous and professional manner through interactions with others.
• Uses a resident and customer-focused approach to problem solving and goal setting.
• Uses discretion in handling confidential information, incorporating all Federal, State and local privacy and confidentiality requirements.
• Must possess knowledge of regulatory compliance and Continuing Care Retirement Community operations.
• Excellent knowledge of Case-Mix, and the Federal Medicare PPS process as required.
• Thorough understanding of the Quality Indicator Process, and OBRA regulations.

• Excellent oral and written communication skills and ability to interface and maintain effective relationships with all departments and employees in a team-oriented environment.
• Computer proficiency using Microsoft Office.
• Must be sensitive to the needs of older adults and enjoy working with a senior population.

Education and Experience:

• Education: Graduation from a School for Registered Nurses is required.
• Work Experience: Minimum 3 years of previous experience in an MDS/Clinical Reimbursement Nurse role is required.
• Licensure / Certification, where required: Current State Licensure as a Registered Nurse in the state where practicing is required. Current CPR and Automated External Defibrillator (AED) certifications are required. Current First Aid certification is required or must be willing and able to become First Aid certified. Food handlers certification, where required.

The application window is anticipated to close within 30 days of the date of the posting.