Dir. of Clinical Assessment and Reimbursement

Overview :

Director of Clinical Assessment & Reimbursement will support, provide assistance and guidance to Franciscan Ministries Skilled Nursing communities MDS nurses and interdisciplinary teams.

Responsibilities will include assessment accuracy, clinical analytics, Medicare billing, and adherence to industry standards following applicable state, federal and organizations policies, procedures, and regulations.

The individual in this role serves as the organizational expert on PDPM, CMS Quality Measures, Medicare billing, Managed Care, Five Star analytics and PBJ.

This role requires moderate travel and remote work supporting seven skilled nursing communities, four in Illinois, two in Ohio and one in Indiana.

Key Duties & Responsibilities

• Oversees the MDS department across Franciscan Ministries Skilled Nursing Communities.
• Ensure that MDS has proper and sufficient training to ensure the best PDPM and CMI outcomes for resident’s acuity and maximize revenue.
• Monitor scheduling of assessments, and timeliness of MDS’s.
• Drive Quality Measure goals to account for the quality of care provided to residents.
• Ensure compliance with CMS, Medicare and federal guidelines.
• Assist centers in the triple check process.
• Implement / update policies and procedures related to reimbursement and care planning.
• Oversee and monitor the center’s ADR (Additional Documentation Request) processes.
• Ensure PBJ hours are correct and submitted per federal regulations.
• Monitor and ensure communities are meeting CMS QRP requirements.
• Assist with completion of MDS’s when needed.
• Train and coach new and current MDS nurses.

Mission & Values

• Supports, upholds, and maintains the Mission & Philosophy of the Franciscan Sisters of Chicago and promotes it in a positive manner in all business interactions within and outside of the Demonstrates loyalty, pride in the Ministry, its associates, and departments.
• Respects and safeguards the confidentiality of information regarding residents, co-workers and the Community, and holds others accountable to the same
• As a leader within the organization, projects a professional and caring demeanor in interactions with residents, family members, visitors, associates, and
• Sets an example by demonstrating an attitude of teamwork when interacting with others within or outside the community.

As such, consistently displays respect for self and for others in manner (body language, dress), word (spoken language) and action (behavior).

• Takes ownership of job responsibilities by initiating prompt and appropriate action / follow-up in all Ensures appropriate and timely resolutions to situations.
• Exhibits resourcefulness and Initiative in anticipating and meeting the needs of residents, co-workers, and subordinates in a pro-active manner.

Encourages and empowers subordinates to perform in the same

• Welcomes feedback, suggestions, and new ideas as an opportunity to learn, grow, and improve
• Promotes and supports the change effort through accurate and timely communication, flexibility, and acceptance.
• Aligns community / departmental goals and objectives with the overall strategic plan of the organization.

III. Position Requirements

In addition to significant experience in the industry, the ideal candidate will show exceptional business aptitude, strategic thinking and creative abilities that reflect a unique understanding of the sector and the clients we serve.

Ideal candidates will have :

• Licensed Registered Nurse.
• 5+ years of experience in clinical leadership, including multi-site
• 5+ years of experience as a Resident Assessment Coordinator.
• High degree of
• Strong communicator and capable of managing and leading
• Ability to multi-task and is able to prioritize projects and deadlines

V. Essential Functions

• This is a field-based position traveling to different communities in all operating Must be effective in functioning in a team approach regardless of the work environment.
• Must be able to function independently and demonstrate flexibility and personal
• The Director Clinical Assessment & Reimbursement is in contact with peers, residents, associates, visitors, and family They should project a friendly caring demeanor.
• Ability to travel 45% of the time.
• Abide by the organization’s policies and
• General Working Conditions
• General office areas as well as throughout the
• Is subject to frequent interruptions by associates, vendors, residents, family members, and
• Is involved with associates, residents, visitors, government agencies / personnel, etc. under all conditions and circumstances.
• Maintains confidential information due to its sensitive nature and in accordance with HIPAA

VII. Physical Demands of the Position

• Must be able to move intermittently throughout the
• Ability to stand, walk, bend, and
• Must possess sight / hearing senses or use prosthetics that will enable these senses to function adequately so that the requirements of this position can be fully
• Must meet the general health requirements set forth by the policies of this community, which include a medical and physical

VIII. Mental Acuity Requirements of the Job

• Must function independently and have flexibility, personal integrity, and the ability to work effectively with the residents, personnel, and support
• Must possess the ability to make independent decisions when circumstances warrant such
• Must possess the ability to deal tactfully with personnel, residents, family members, visitors, government agencies / personnel, and the general
• Must be knowledgeable of healthcare regulations, laws, and guidelines governing the long-term care
• Must possess leadership ability and willingness to work harmoniously with other personnel.
• Must be able to read, analyze, and interpret the most complex

IX. Technical / Motor Skill Requirements of the Job

• Must be able to speak and write the English language in an understandable
• Must be able to communicate with people of all professional and social
• Must be proficient in Microsoft Office and other common software application, PCC experience preferred.
• Must possess the ability to use general office

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