Clinical Reimbursement Consultant Coastal Region

SanStone Health & Rehabilitation is seeking a Regional MDS Nurse for the Coastal Region of North Carolina. The Regional MDS Nurse will collaborate with the Regional Administrators, facility Administrators, MDS Coordinators and Directors of Nursing to ensure excellent survey outcomes and exceptional quality of care for the residents we serve.

Regional MDS provides support, education, and training to the MDS Coordinators in the facilities on the Resident Assessment Instrument (RAI) process in accordance with the laws, regulation, and company standards. Reviews and coordinates PDPM and Case Mix data for the region to ensure appropriate reimbursement.

Job Requirements:

• Current license as a Registered Nurse issued by the State Board of Nursing
• Bachelor’s degree or Associate degree in nursing from accredited college
• Minimum 3 + years’ experience with the RAI process
• Prior multi-facility experience a plus
• Strong Knowledge of PDPM and State Case Mix Time weighted Reimbursement payment system.
• Knowledgeable of the nursing and medical practices and procedures, as well as laws, regulations, and guidelines that pertain to long-term care.
• Effective verbal and written English communication skills.
• Ability to communicate at all levels of the organization and work well within a team environment in support of company objectives.
• Customer service oriented with the ability to work well under pressure.
• Strong attention to detail and accuracy, excellent organizational skills with ability to prioritize, coordinate and simultaneously maintain multiple projects with high level of quality and productivity.
• Ability to work with minimal supervision, take initiative and make independent decisions.
• Approachable, flexible, and adaptable to change.
• Function independently, and have flexibility, personal integrity, and the ability to work effectively with employees and vendors.
• Demonstrate basic to intermediate skills in Microsoft Word, Excel, Power Point, and Internet navigation, preferred.
• High level of professionalism with the ability to maintain confidentiality.
• Ability to travel.

Responsibilities:

• Provides leadership, oversight and acts as a resource for regional and facility staff specific to the RAI process, the Medicare program, and Medicaid Case Mix as applicable.
• Conducts regular monitoring of facility Medicare management and Case-Mix
• Works in coordination with the Regional Nurse Consultant to provide regional and facility interdisciplinary (IDT) teams with education and support for the development of systems to address and manage Quality Measures (QM) and the CMS Five Star Rating.
• Supports accurate claims and billing.
• Leads and participates in program improvement and development efforts related to the RAI, Medicare and Medicaid programs.
• Conducts follow-up evaluations to validate those systems are functioning well after initial roll-out.
• Participates in the Quality Assurance Process Improvement Program:
• Identifies and evaluates trends
• Assists with Root Cause Analysis
• Assists in identifying appropriate solutions
• Supports facility follow-up through appropriate measurement design
• Participates during “mock survey” process related to RAI with Regional Team as requested, and preparation for state and federal surveys as assigned.