Regional Director of Clinical Reimbursement

Extendicare Health Services Inc. of Milwaukee, Wisconsin, is a wholly owned subsidiary of Extendicare Inc., and is a major provider of long-term care and rehabilitation services in the United States.  Extendicare Health Services owns and/or operates 148 long-term care facilities with capacity for 14,882 residents. 

 

Responsible for auditing and analyzing the MDS document for accuracy, planning and training MDS Coordinators, Directors of Nursing and other key EHSI employees.  This training will cover MDS systems, case mix management, RUGS, and other clinical systems and processes that impact the facility reimbursement. Partner with the Clinical and Financial team to develop and enhance clinical reimbursement tools and systems. Ensure that reimbursement structures are managed, evaluated, and capture accurate resource utilization at the facility level.

 



MINIMUM

QUALIFICATIONS:

 

PHYSICAL

REQUIREMENTS:  Ability to lift 40 lbs.

 

EDUCATION: RN License, preferred.

 

EXPERIENCE: Qualified candidates must have skilled nursing care experience and 1-3 years previous experience as an MDS Coordinator or MDS Consultant. Previous multi-facility management preferred.  Strong understanding of PPS Medicare Reimbursement and Case Mix Medicaid Reimbursement a must.



 

SKILLS, KNOWLEDGE & ABILITIES: 

 

Expert knowledge in the RAI process. Working knowledge and understanding of regulatory processes i.e. JCAHO, Federal and/or State.  Flexibility to travel 70-80% of the time.  Knowledge of clinical cost management relating to staffing and clinical cost analysis of care systems.  Must also possess the following management abilities:  planning; organizing; leadership; analyzing; cooperation; flexibility; and decision-making.  Also prefer a personal profile that demonstrates:  problem solving; creativity; communication; motivation; emotional adjustment; accuracy and thoroughness in completing assignments.

 

DUTIES AND

RESPONSIBILITIES: 

 

ESSENTIAL  DUTIES:

 

1.  Provide instruction to MDS Coordinators and MDS Nurses, the IPOC team and regional staff on the MDS/RAI process.

2.  Assist Administrators in recruitment, orientation, evaluation, and retention of MDS Coordinators.

3.  Evaluate the case management process within the facilities.

4.  Assist the IPC team in developing a plan of action to improve the clinical reimbursement process including:

?  Validate accuracy of MDS data

?  Reduce and eliminate MDS defaults

?  Ensure proper Medicare certification/recertification procedures are in place

?  Monitor Medicare length of stay

?  Ensure accurate case mix indices are assigned to residents

?  Monitor and enforce corporate MDS submission guidelines

?  Educate regarding selection of appropriate assessment reference dates

?  Improve efficiency of IPOC process

?  Partner with the Therapy program

?  Evaluate and enhance the Restorative nursing program

?  Evaluate and improve the admission process

?  Partner with Medical Review to ensure that accurate ADR information is submitted to the fiscal intermediaries

?  Assist in the Medicare appeal process

?  Review Medicaid state audit results and implementation of plans of corrections.

5.  Serve as the area resource for RAI information.  Provide education and in-servicing as identified.

6.  Track trends, report to and make recommendations to the ADCM, RDO, Rehab Director and Area Controller on all aspects of reimbursement.

7.  Serve as liaison between Area Controller, Area Rehab Director, Field Analyst, other area staff, and the facility IPOC teams to enhance reimbursement outcomes.

8.  In conjunction with the RNC, serve as a resource in compliance activities and as a support for survey preparation.

9.  Implement and maintain Clinical Programs and basic systems related to reimbursement.

10.  Monitor outcomes and direct facilities in improving outcomes.

11.  Maintain current information on OBRA regulations, licensure requirements, JCAHO, and other regulatory and agency standards.

12.  Adhere to and support the purpose, philosophy, objectives, policies and procedures of the corporation.

 

Please submit resumes to pknapp@extendicare.com