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:

1. 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.
2. Provides/ensures accurate documentation of all services in order to maximize accurate reimbursement from all payor sources.
3. Completes all performance reviews with staff along with hiring of new staff.
4. Selects, trains/orients and assigned department staff.        Develops standards of performance, evaluates performance, and initiates or makes staff recommendations.
5. Reviews facility quality indicators, assisting  as needed with identifying strengths and weaknesses of data and how it relates to facility care practices
6. Manages the patient’s Medicare benefit by communication of skilled needs to the patient, family and interdisciplinary care team.  
7. Organize and participate in the daily Medicare meeting, utilization review and monthly end of close meetings.  
8. Assists with Medicare denial claims/reviews when need is identified by billing office.
9. 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.
10. Continually upgrades and makes changes in job area to assure that departments meet the needs to the changing market, federal and/or state mandates.
11. 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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