Regional Director of Case Management & Reimbursement

Healthcare Nursing Center of Hartford; Hartford (CT); On-site; USD 110,000 - 170,000; Full time

Benefits offered by this job

Medical Insurance

PTO

Paid Holidays

Career Growth

Job summary

Healthcare Nursing Center of Hartford is seeking a Regional Director of Case Management & Clinical Reimbursement to lead the RAI process, care planning, and regulatory compliance, improving patient access to benefits. The role collaborates with Regional Case Managers and facility teams to monitor processes, guide Utilization Review meetings, and analyze PDPM and RUGs data for improvement opportunities.

Must ensure ongoing staff education and adherence to Medicare, Medicaid, and managed care

Qualifications

• Must possess a degree in Nursing from an accredited school or be a graduate of an approved RN program.
• RAC certification preferred.
• Experience in a hospital, nursing care facility, or related healthcare facility.
• Working knowledge of Medicare, Medicaid, managed care programs, the RAI process, clinical reimbursement, and compliance regulations and guidelines.
• Experience using Microsoft Word, Excel, and electronic medical record (EMR) systems.

Responsibilities

• Provide education, support, and review of Medicare, Medicare Advantage, commercial insurance, and Medicaid cases to maximize reimbursement and maintain compliance.
• Collaborate with Regional Case Managers and facility teams to monitor processes and ensure appropriate follow-through.
• Provide guidance and support for facility Utilization Review meetings.
• Conduct analytical reviews of PDPM and RUGs reimbursement data to identify trends and opportunities for program development and operational improvement.
• Ability to respond quickly and effectively in emergency patient care situations.
• Oversee the hiring, onboarding, and ongoing education of Case Management nurses
• Provide continued training and support related to reimbursement, compliance, and case management processes

Education

Nursing degree

Tools

Microsoft Word

Microsoft Excel

EMR systems

Job description

Healthcare Nursing Center of Hartford is seeking a Regional Director of Case Management & Clinical Reimbursement to lead the RAI process, care planning, and regulatory compliance, improving patient access to benefits. The role collaborates with Regional Case Managers and facility teams to monitor processes, guide Utilization Review meetings, and analyze PDPM and RUGs data for improvement opportunities.

Must ensure ongoing staff education and adherence to Medicare, Medicaid, and managed care