Regional Director of Reimbursement at Caraday Management LLC

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.