Regional Reimbursement Nurse

Opco-Skilled-Management-; New Mexico; On-site; USD 90,000 - 115,000; Full time

Benefits offered by this job

Healthcare

Dental

Vision

PTO

401K

Job summary

OPCO Skilled Management seeks a Regional Reimbursement Coordinator to manage MDS services across multiple facilities, ensuring quality care and fiscal responsibility through training and program reviews aligned with Medicare, Medicaid, OBRA and related regulations.

This role trains MDS staff, ensures accurate resident assessments, and coordinates with Compliance Team to optimize reimbursement while maintaining high standards of nursing practice.

Qualifications

• RN license in state of practice required.
• Associate or Bachelor's degree from an accredited nursing school required.
• Minimum of five years in long-term or acute health care.
• Minimum of five years working as an MDS Nurse in long-term or acute health care.
• At least three years of multi-facility, regional MDS experience.

Responsibilities

• Consults with and provides technical assistance to the MDS Coordinators through visits and interpretation of policies and regulations.
• Trains new MDS Coordinators in resident assessments, plans of care, and documentation of clinical records.
• Ensures training on RAI manual and MDS deadlines.
• Oversees compliance with nursing standards and federal/state/local regulations.
• Supports facility leadership to maximize resident satisfaction and care outcomes.
• Develops metrics for quality of care and reporting on QM measures.

Job description

Job Type: Full-Time

Benefits Offered:

• Healthcare
• Dental
• Vision
• PTO
• 401K

Job Summary

The Regional Reimbursement Coordinator will be responsible for management of clinical leadership teams in the development, implementation, coordination and evaluation of MDS services across multiple facilities. Supports quality care and fiscal responsibility through comprehensive MDS training and support services for assigned region. Responsible for the training and program review of MDS Services in accordance with Federal, State and Local laws and governing entity regulations (PDPM, PASSAR exp required).

Qualifications

• Currently licensed as RN in the state practiced.
• Associate or bachelor’s degree from an accredited nursing school required.
• Minimum of five (5) years in long-term or acute health care required,
• Minimum of five (5) years working as an MDS Nurse in long-term or acute health care
• At least three (3) years of multi-facility, regional MDS experience

RESPONSIBILITIES

• Consults with and provides technical assistance to the MDS Coordinators through visits and the interpretation or clarification of policies and regulations.
• Trains new MDS Coordinators in conducting resident assessments, developing plans of care, evaluating residents’ responses to interventions and documenting clinical records.
• Trains new MDS Coordinators on the RAI manual and all applicable deadlines for resident assessments and completion of Minimum Data Sets (MDSs).
• Observes MDS and related practices for compliance with standards and regulations.
• Regularly inspects the facility and nursing practices for compliance with standards of nursing practice and federal, state and local regulations
• May be required to assume the role of interim MDS Coordinator, as needed.
• Ability to train facility MDS regarding company best practices including consistent coordination with other members of Compliance Team i.e. DON, BOM, Medical Records, and Therapy to ensure compliant billing.
• Leads the facility management staff and consultants in developing and working from a business plan that focuses on all aspects of facility operations, including clinical management.
• Responsible for developing and implementing appropriate metrics and benchmarks for company's quality of care, against which performance is evaluated.
• Regularly advises and directs Clinical Support Team, Director of Nursing to maximize resident satisfaction and wellbeing.
• Develops and utilizes a standardized process to evaluate and evolve practice to decrease variability and improve the care and safety of patients.
• Responsible for developing, implementing and monitoring quality management policies and procedures for quality data collection and reporting on QM measures.
• Conduct ongoing assessments of the existing eligibility and referrals, case management, disease management systems, and Quality Management programs within each clinical. Provide objective evaluation and recommendations for those systems.
• Review existing clinic information system capabilities for the tracking and monitoring of quality indicators. Make the necessary adaptations for standardized reporting across all centers
• Resident Assessment Instrument (RAI) guidelines are followed in the assigned region with focus on resident care and mixing financial reimbursement through the MDS process. Responsible for ensuring accurate and timely completion of resident assessments, in accordance with Medicare, Medicaid, OBRA and other payer program requirements.
• Utilizes and manages the distribution and utilization of survey information to address areas of importance as defined by our community and service partners.
• Ensure regulatory compliance to all federal, state and local regulations and laws relating to nursing home administration; guide facilities to operate within established company policies and practices
• Ensures each facility maintains building and grounds to appropriate standards and that equipment and work areas are clean, safe and orderly, and any hazardous conditions are addressed; ensure that Universal Precaution and Infection Control, Isolation, Fire Safety and Sanitation practices and procedures are followed.
• Helps the Administrator prepare staff for inspection surveys, instructing staff on matters of conduct and disclosure, being interviewed by inspectors, immediate corrections of problems noted by surveyors, etc. Reviews and reinforces important standards previously cited.
• Participates in the preparation of the Plan of Correction response to an inspection survey and implements any followup QA required for any nursing allegations.
• Provides 24-hour “on call” service to the nursing center in case of emergency.
• Assures that an adequate orientation and in-service training program is provided for MDS personnel.
• Other duties, responsibilities and activities may change or assigned at any time with or without notice.

OPCO Skilled Management provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type 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.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.