What are the responsibilities and job description for the Director of Medical Review position at Creative Solutions in Healthcare?
Job Title: Director of Medical Review - Long-Term Care
Location: Fort Worth, TX (not remote)
About Us: At Creative Solutions in Healthcare, we are committed to providing high-quality, compassionate care to residents in our long-term care facilities. We believe in fostering an environment where our staff can grow and thrive while making a significant impact on the lives of the individuals we serve. As a leading provider in the long-term care industry, we are seeking an experienced and strategic Vice President of Finance to join our team.
We offer a comprehensive and competitive benefits package that includes:
- Health/Dental/Vision Insurance
- Ancillary policies including AD&D, STD, Cardiac, Cancer, Critical Illness, Hospital Confinement
- Whole and Term Life Insurance
- Tuition Reimbursement
- Paid Time Off
- Immediate 401(k)
- Unparalleled Corporate Support
Summary:
This is a full-time position which will report to the Vice President of Clinical Reimbursement to complete the medical review response for audits, involving all payer sources, for skilled nursing facilities. Please review responsibilities and qualifications carefully before applying.
Responsibilities:
- Review data requests from CMS (MAC, RAC, CERT, SMRC, ZPIC, TPE), OIG, or managed care contractors.
- Demonstrates consistent knowledge and application of Medicare and other reimbursement regulations.
- Ensures accuracy and reconciliation of data in accordance with deadlines.
- Timely completion of appeals/redeterminations when appropriate.
- Assist Reimbursement team with collection of Therapy documents for OIG RUG Reviews.
- Complete necessary OIG reconsiderations as needed.
- Effective written and verbal communication skills to provide feedback regarding specific programs, objectives, problems and successes.
Qualifications:
- 3-5 years in long term care and/or medical record/review related positions preferred.
- Knowledge of MDS RAI processes and PDPM payment components.
- Knowledge of CMS regulatory resources and PDPM management preferred.
- Ability to navigate EHR system, PCC experience preferred.
- Ability to navigate Therapy Software, NetHealth experience preferred.
- Microsoft Office proficiency required, with the aptitude to learn new programs as needed, being computer savvy is necessary.
- Highly motivated and detail-oriented professional with excellent analytical and organizational skill set.
- Capable of working independently and as part of a team
- Adept skillset for multi-tasking, sense of urgency, ability to prioritize.
- Ability to effectively communicate with a wide range of individuals, professional demeanor is imperative.
We are an equal opportunity employer and prohibit discrimination/harassment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
