Regional Director of Case Management and Reimbursement

Marquis Health Consulting Services -

We are seeking an experienced Regional Director of Case Management and Reimbursement to support our MDS reimbursement & Care Navigation teams in our Massachusetts market.

The Regional Director of Case Management and Reimbursement will work under the direction of the VP of Case Management.

The Regional Director of Case Management and Reimbursement assures the implementation of company policies and procedures pertaining to the Medicare and Managed care reimbursement and care management in the facilities.

Regional Director of Case Management and Reimbursement is r esponsible for regulatory compliance and quality improvement efforts in order to attain appropriate Medicare or Managed Care reimbursement.

This position integrates information from all necessary disciplines to maintain accuracy and compliance with the MDS process and care coordination.

By conducting concurrent MDS reviews, he / she assures the achievement of maximum allowable HIPPS / RUG categories and appropriate length of stay management through effective care coordination through the care continuum.

The consultant is also responsible for regulatory compliance and quality improvement efforts in appropriate care coordination and coordination of benefits.

Working collaboratively with facility team members, the Consultant ensures that services offered meet or exceed federal, state and company standards and serves as a role model for ethical business practices according to health standards.

ESSENTIAL DUTIES & RESPONSIBILITIES

RN or LPN

Multisite Skilled Nursing center management experience required

Job Functions include but are not limited to :

• Provides consultation, training and support concerning the MA Medicaid, Medicare, Managed Care, and state case mix payment system for the assigned area.
• Analyzes systems and processes to determine that federal and state regulations as well as company policies and procedures are followed.

Supporting documentation, and other relevant data.

• Responsible for overseeing and completing PDPM and MDS OBRA completion as needed, responsible for compliance and reimbursement maximization.
• Studies, analyze and reports period over period information and systems in order to identify trends and deviations from results in Medicare and takes appropriate actions.
• Works in conjunction with teams to resolve issues effecting deviations from expected results. Recommends changes and performs follow-up to ensure that those recommendations are effectively implemented and monitored for appropriateness.
• Provides consultation, training and support concerning coordinating, and facilitating the clinical progression of the patient's treatment and discharge plan.
• Analyzes systems and process to determine that federal and state regulations as well as company policies and procedures are followed.

Supporting documentation in support of appropriate plan of care development and delivery with appropriate length of stay and cost management of care delivery.

• Regularly communicates to management outside the facility on recommendations made to facility management to ensure proper implementation and follow-up.
• Salary based on experience.

INDHP