Director of Clinical Reimbursement

We are searching for a full-time Director of Clinical Reimbursement, RN.

Annual Salary Range: $94,000.00 to $110,000.00 (commensurate with experience)

This position plays a major role in the accuracy of clinical documentation as it pertains to Resident care planning, documentation and coding and the revenue maximization via the accuracy of coding and EMR documentation.

At Mary Wade you will experience a high quality professional culture focused on resident needs. We strive to deliver the highest quality clinical care with deep compassion and empathy for long term care and short term rehab. If you find meaning working in direct care in a medical setting, working in our skilled nursing facility may be for you.

Due to excellent patient to aide ratios, we take the time to talk with, and listen to, those we care for and do whatever it takes to get the job done. Our goal is to create moments of joy as often as possible. Listening to understand, demonstrating kindness, concern and tender loving care are part of our core practices. Stringent infection control guidelines are followed to ensure resident and employee safety.

We have 94 beds. Our resident population is primarily seniors with varying levels of acuity.

For 156 years we have been serving the Greater New Haven senior community. We are a mission focused non-profit, governed by a Board of Trustees. Visit www.marywade.org to see our gorgeous campus and learn more about our services and history.

Job Duties include the following but not limited to:

• Coordination of the facilitys Resident Assessment Instrument (RAI) process in accordance with state and federal regulations.
• Accurate completion of all MDS assessments and any supporting assessments or clinical documentation.
• Implementing and ongoing evaluation of each residents comprehensive plan of care.
• Scheduling and leading interdisciplinary care plan team meetings.
• Responsible for the resident care planning process
• Oversee other team members in the MDS department
• Auditing medical records for the presence of supporting documentation for all items coded on the MDS. Provide education to department heads, physicians, and other staff as needed.
• Collaborating with health plans, physicians, and the interdisciplinary team for assuring insurance approvals and/or that residents meet eligibility and coverage criteria.
• Interpreting rules, regulations and coverage guidelines and acting as primary resource for problem solving regarding SNF PDPM payment system and quality reporting program
• Serves as coordinator between medical staff, nursing, and other operational departments with respect to the resident care planning process with utilization of the MDS.
• Develops and analyzes quality assessment indicators for use in monitoring performance under OBRA regulations regarding practice and documentation of the MDS and resident care plan.
• Analyzes and evaluates clinical and operational systems relative to OBRA requirements and makes recommendations.
• Serves as the primary resource person for the dissemination of information regarding care planning including proposed changes in regulations and needs, assists Director of Nursing in completion of required RAI documentation.

Qualifications include the following:

• Active CT RN License
• 2 - 3 years experience in long term care nursing home environment.
• 1-2 years' experience as a MDS Coordinator.
• Sensitivity to the needs of the elderly in a healthcare setting.
• Good interpersonal and communication skills.
• Ability to read, analyze, and interpret nursing policies and procedures, journals, OBRA and JACHO regulations, state public health code, and federal regulation. Ability to write reports. Ability to effectively present information and respond to questions from staff members, residents, resident families, visitors, physicians, and other consultants.