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RN MDS Manager

Company: Masonicare Corp
Location: Wallingford
Posted on: May 16, 2022

Job Description:

Job Description Masonicare Health Center - Wallingford, CTFull Time/Exempt roleThe Manager of 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:

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

Keywords: Masonicare Corp, New England , RN MDS Manager, Executive , Wallingford, Northeast

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